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["COVID-19 Nonparticipating Transmittal Form (Form e-316CV)\nForm e-316CV should only be submitted by primary insurance carriers, brokers, or agents",null,null,null,null,null,"Please Select Primary Carrier"]
["Health care providers volunteering without compensation as described in",null,null,"PA Bulletin Notice 2020-8",null,null,"ACCELERANT SPECIALTY INSUR CO 403"]
["Primary Carrier","Please Select Primary Carrier",null,null,null,null,"ACCREDITED SURETY & CASUALTY CO INC 391"]
["Carrier Code",{"$f":"IF(B3=\"Please Select Primary Carrier\",\"\",RIGHT(B3,3))","v":""},null,null,null,null,"ACE USA (ACE American/INA/Pacific Emp) 023"]
["Date","Completion Date",null,null,null,null,"ADMIRAL INSURANCE COMPANY 113"]
["Contact Person's Name",null,null,null,null,null,"AFFILIATES INSUR RECIPROCAL RRG 303"]
["Contact Person's Address",null,null,null,null,null,"AIG SPECIALTY INSUR CO 276"]
["Contact Person's Telephone #",null,null,null,null,null,"AIX SPECIALTY INSUR CO 327"]
["Contact Person's Email",null,null,null,null,null,"ALLIED PROFESSIONALS RRG 264"]
["For a listing of related numbers for Hospitals and Nursing Homes,",null,null,null,"click here.",null,"ALLIED PROPERTY & CASUALTY INS CO 343"]
["License Number","Name\nLast, First, M.I.","From Date","To Date","Carrier's Policy #","Related #","ALLIED SERVICES RRG 243"]
[null,null,null,null,null,null,"ALLIED WORLD ASSURANCE CO 318"]
[null,null,null,null,null,null,"ALLIED WORLD INSUR CO 354"]
[null,null,null,null,null,null,"ALLIED WORLD SURPLUS LINES INSUR CO 261"]
[null,null,null,null,null,null,"AMCO INSURANCE CO 335"]
[null,null,null,null,null,null,"AMERICAN EMPIRE SURPLUS 179"]
[null,null,null,null,null,null,"AMERICAN HOME ASSURANCE 274"]
[null,null,null,null,null,null,"APPLIED MEDICO-LEGAL SOLUTION 289"]
[null,null,null,null,null,null,"ARCH SPECIALTY INSUR CO 326"]
[null,null,null,null,null,null,"ASPEN SPECIALTY INSURANCE COMPANY 337"]
[null,null,null,null,null,null,"BCS INSURANCE COMPANY 252"]
[null,null,null,null,null,null,"BIFURCATED SYSTEM RESOURCE RRG INC 393"]
[null,null,null,null,null,null,"BRIDGEWAY INSURANCE COMPANY 386"]
[null,null,null,null,null,null,"BROADLINE RRG 310"]
[null,null,null,null,null,null,"CAMPMED CASUALTY & INDEM 208"]
[null,null,null,null,null,null,"CAPITOL SPECIALTY INS COR 256"]
[null,null,null,null,null,null,"CARE RRG INC 321"]
[null,null,null,null,null,null,"CARING COMMUNITIES, RECIPROCAL RRG 298"]
[null,null,null,null,null,null,"CASSATT RRG 156"]
[null,null,null,null,null,null,"CENTRAL PENNSYLVANIA PHYS 219"]
[null,null,null,null,null,null,"CHUBB CUSTOM INS CO 307"]
[null,null,null,null,null,null,"CINCINNATI INSURANCE CO 137"]
[null,null,null,null,null,null,"CLEAR BLUE SPEC INS CO 398"]
[null,null,null,null,null,null,"CLINICIAN ASSURANCE INC RRG 379"]
[null,null,null,null,null,null,"CNA-CONTINENTAL CASUALTY 011"]
[null,null,null,null,null,null,"COLUMBIA CASUALTY INS CO 145"]
[null,null,null,null,null,null,"COMMUNITY HOSPITAL RRG 197"]
[null,null,null,null,null,null,"CONTINUING CARE RRG 269"]
[null,null,null,null,null,null,"COPIC A RRG 381"]
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[null,null,null,null,null,null,"COVERYS SPECIALTY INSUR CO 347"]
[null,null,null,null,null,null,"CRUDEN BAY RRG, INC 218"]
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[null,null,null,null,null,null,"DOCTORS COMPANY RRG 359"]
[null,null,null,null,null,null,"DOCTORS PROFESSIONAL LIABILITY RRG 380"]
[null,null,null,null,null,null,"DREXEL UNIV & COLLEGE OF MEDICINE S68"]
[null,null,null,null,null,null,"EMERGENCY CAPITAL MGMT LLC  RRG 323"]
[null,null,null,null,null,null,"EMERGENCY MED PROF RRG 251"]
[null,null,null,null,null,null,"EMPRO INSURANCE COMPANY 395"]
[null,null,null,null,null,null,"ENDURANCE AMERICAN SPECIALTY INS CO 358"]
[null,null,null,null,null,null,"EVANSTON INSURANCE CO 103"]
[null,null,null,null,null,null,"EVEREST INDEMNITY INS CO 194"]
[null,null,null,null,null,null,"EXCELA RECIPROCAL RRG 341"]
[null,null,null,null,null,null,"FAIR AMERICAN INSUR & REINSUR CO 328"]
[null,null,null,null,null,null,"FIRST MEDICAL INS CO RRG 199"]
[null,null,null,null,null,null,"FRANKLIN CASUALTY INS CO 155"]
[null,null,null,null,null,null,"FUTURE CARE RRG 378"]
[null,null,null,null,null,null,"GEISINGER INSUR CO RRG 245"]
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[null,null,null,null,null,null,"GRAPH INSURANCE GROUP RRG LLC 377"]
[null,null,null,null,null,null,"GREAT AMERICAN INSUR CO 055"]
[null,null,null,null,null,null,"GREEN HILLS INSUR CO RRG 237"]
[null,null,null,null,null,null,"GUTHRIE RRG 241"]
[null,null,null,null,null,null,"HALLMARK SPECIALTY INS CO 348"]
[null,null,null,null,null,null,"HEALTH CARE INDUSTRY RRG 236"]
[null,null,null,null,null,null,"HEALTHCARE PROF RRG INC 396"]
[null,null,null,null,null,null,"HOMESITE INS CO OF FL 389"]
[null,null,null,null,null,null,"HUDSON EXCESS INS CO 384"]
[null,null,null,null,null,null,"HUDSON SPECIALTY INS CO 244"]
[null,null,null,null,null,null,"ILLINOIS UNION INSUR CO 232"]
[null,null,null,null,null,null,"INTERSTATE INS CO RRG INC 385"]
[null,null,null,null,null,null,"IRONSHORE SPECIALTY INS 286"]
[null,null,null,null,null,null,"ISMIE INDEMNITY CO 367"]
[null,null,null,null,null,null,"ISMIE MUTUAL INS CO 364"]
[null,null,null,null,null,null,"KINSALE INSUR CO 332"]
[null,null,null,null,null,null,"KNIGHT SPECIALTY INSURANCE CO 394"]
[null,null,null,null,null,null,"LANDMARK AMERICAN INS CO 247"]
[null,null,null,null,null,null,"LECOM HEALTH RRG 382"]
[null,null,null,null,null,null,"LECOM HEALTH S54"]
[null,null,null,null,null,null,"LEHIGH VALLEY RRG 222"]
[null,null,null,null,null,null,"LEXINGTON INSURANCE CO 003"]
[null,null,null,null,null,null,"LIBERTY INSURANCE UNDERWRITERS INC 373"]
[null,null,null,null,null,null,"LIBERTY SPLTY MKTS BERMUDA LTD 376"]
[null,null,null,null,null,null,"LIBERTY SURPLUS INS CO 308"]
[null,null,null,null,null,null,"LLOYDS - BEAZLEY FURLONGE LIMITED 361"]
[null,null,null,null,null,null,"LLOYDS - DALE MANAGING AGENCY LIMITED 402"]
[null,null,null,null,null,null,"LLOYDS OF LONDON 052"]
[null,null,null,null,null,null,"LONE STAR ALLIANCE INC 350"]
[null,null,null,null,null,null,"LTC INS CO RRG LLC 388"]
[null,null,null,null,null,null,"MAG MUTUAL INS CO 369"]
[null,null,null,null,null,null,"MCIC VERMONT INC RRG 280"]
[null,null,null,null,null,null,"MDADVANTAGE INS CO OF NEW JERSEY 346"]
[null,null,null,null,null,null,"MEDICAL MUTUAL LIAB INS SOC 030"]
[null,null,null,null,null,null,"MEDICAL MUTUAL INSUR CO OF NC 351"]
[null,null,null,null,null,null,"MEDICAL SECURITY INSUR CO 334"]
[null,null,null,null,null,null,"MEDMAL DIRECT INSUR CO 345"]
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[null,null,null,null,null,null,"MIDWEST INS GROUP INC RRG 270"]
[null,null,null,null,null,null,"MOUNTAIN LAUREL RRG, INC. 207"]
[null,null,null,null,null,null,"NATIONAL GUARDIAN RRG INC 206"]
[null,null,null,null,null,null,"NATIONAL UNION FIRE INSUR 275"]
[null,null,null,null,null,null,"NATL FIRE & MARINE INS CO 127"]
[null,null,null,null,null,null,"NEW YORK HEALTHCARE INS CO RRG 401"]
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[null,null,null,null,null,null,"NOTTING HILL RRG LLC 404"]
[null,null,null,null,null,null,"OLD REPUBLIC INSURANCE CO 112"]
[null,null,null,null,null,null,"OLD REPUBLIC SURPLUS LINES 405"]
[null,null,null,null,null,null,"OPHTHALMIC MUTUAL INS CO 138"]
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[null,null,null,null,null,null,"PACE RISK RETENTION GROUP 220"]
[null,null,null,null,null,null,"PALLADIUM RRG 338"]
[null,null,null,null,null,null,"PEACE CHURCH RRG, INC. 235"]
[null,null,null,null,null,null,"PELICAN INS A RECIP RRG 217"]
[null,null,null,null,null,null,"PENN MANUFACTURERS ASSOC 038"]
[null,null,null,null,null,null,"PENN STATE HEALTH S69"]
[null,null,null,null,null,null,"PHILA INDEMNITY INSUR CO 165"]
[null,null,null,null,null,null,"PHILA PROTESTANT HOME S61"]
[null,null,null,null,null,null,"PHOEBE RECIPROCAL RRG 242"]
[null,null,null,null,null,null,"PHYSICIANS INSURANCE RRG 353"]
[null,null,null,null,null,null,"PODIATRY INSURANCE CO 124"]
[null,null,null,null,null,null,"POSITIVE PHYSICIANS INS CO 239"]
[null,null,null,null,null,null,"PREFERRED PHYSICIANS MEDICAL RRG INC 294"]
[null,null,null,null,null,null,"PREFERRED PROF INSUR CO 129"]
[null,null,null,null,null,null,"PROASSURANCE INDEMNITY CO INC 349"]
[null,null,null,null,null,null,"PROASSURANCE SPEC INS CO 324"]
[null,null,null,null,null,null,"PROFESSIONAL SECURITY INS CO 370"]
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[null,null,null,null,null,null,"PROSELECT INSURANCE CO 271"]
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[null,null,null,null,null,null,"SCOTTSDALE INSURANCE CO 110"]
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[null,null,null,null,null,null,"SIGMA RRG 290"]
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[null,null,null,null,null,null,"ST. CLAIR MEM HOSP S40"]
[null,null,null,null,null,null,"STARSTONE SPEC INSUR 322"]
[null,null,null,null,null,null,"STC HEALTHCARE PARTNERS RRG 374"]
[null,null,null,null,null,null,"STEADFAST INSURANCE CO 196"]
[null,null,null,null,null,null,"SUNLAND RRG INC 397"]
[null,null,null,null,null,null,"TDC SPECIALTY INSUR CO 173"]
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[null,null,null,null,null,null,"THE DOCTORS COMPANY 121"]
[null,null,null,null,null,null,"THE HANOVER ATLANTIC INS CO LTD 392"]
[null,null,null,null,null,null,"THE MEDICAL PROTECTIVE CO 031"]
[null,null,null,null,null,null,"TITAN RRG 372"]
[null,null,null,null,null,null,"TOWER HEALTH RECIPROCAL RRG 365"]
[null,null,null,null,null,null,"TRI-CENTURY INSURANCE CO 144"]
[null,null,null,null,null,null,"TRISURA SPECIALTY INSURANCE COMPANY 399"]
[null,null,null,null,null,null,"WELLSPAN RECIPROCAL RRG 224"]
[null,null,null,null,null,null,"WESLEY ENHANCED LIVING S67"]
[null,null,null,null,null,null,"XL CATLIN INS CO UK LTD 383"]
[null,null,null,null,null,null,"MCARE TEST CO 000"]