Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-15 - Surplus line insurance › Section 284-15-030 - Surplus line brokers' form to be filed - Contract statement to be used

Current through Register Vol. 24-14, July 15, 2024
(1) For the purpose
			 of complying with the requirements of
			 RCW
			  48.15.043 and
			 48.15.040, the date insurance is
			 procured is the date coverage is bound or the date coverage is effective,
			 whichever is later. The certification required by
			 RCW
			  48.15.040 must be in substantially the
			 following form, and may include additional information to satisfy requirements
			 of the Surplus Line Association of Washington:
Policy or
Certificate No:
Premium, including
any policy fee:
1.
Name and license number of filing Surplus Line
							 Broker:
2.
Name and address of referring insurance producer (if
							 any):
3.
Name(s) of unauthorized insurer(s):
4.
Name and address of insured:
5.
Binding or effective date, whichever is later:
6.
Brief statement of coverages (common trade terms may
							 be used, e.g. "furrier's block"):
7.
Certification:
I have procured insurance from an unauthorized insurer or
				insurers, in accordance with the laws and regulations of the state of
				Washington under my surplus line broker's license. Details of such transaction
				are set forth above.
The insurance could not be procured, after diligent effort was
				made to do so from among a majority of the insurers authorized to transact that
				kind of insurance in this state, and placing the insurance in such unauthorized
				insurer(s) was not done for the purpose of securing a lower premium rate than
				would be accepted by any authorized insurer.
I certify that I am duly authorized to place this coverage on
				behalf of the insured, that the risk has been duly accepted by the insurer(s),
				and that the financial condition of the unauthorized insurer(s) before placing
				the insurance therewith meets or exceeds the financial requirements provided by
				law.
I certify that under the penalty of the suspension or
				revocation of my surplus line broker's license that the facts contained in this
				certification are true and correct.
. . . . . . . . . . ..
(Signature of Surplus Line Broker)
. . . . . (Date)
(2)
			 Every insurance contract, including those evidenced by a binder, procured and
			 delivered on or after January 1, 2012, as a surplus line coverage under chapter
			 48.15 RCW must have a conspicuous statement upon its face, which must be
			 initialed by or bear the name of the surplus line broker who procured it, as
			 follows:
"This contract is registered and delivered as a surplus line
				coverage under the insurance code of the state of Washington,
				Title
				48 RCW. It is not protected by
				any Washington state guaranty association law."
(3) Every insurance contract, including those
			 evidenced by a binder, procured and delivered on or before December 31, 2011,
			 as a surplus line coverage under chapter 48.15 RCW must have a conspicuous
			 statement upon its face, which must be initialed by or bear the name of the
			 surplus line broker who procured it, either as set forth in subsection (2) of
			 this section, or as follows:
"This contract is registered and delivered as a surplus line
				coverage under the insurance code of the state of Washington, enacted in 1947.
				It is not issued by a company regulated by the Washington state insurance
				commissioner and is not protected by any Washington state guaranty fund
				law."
Statutory Authority:
				  RCW
				  48.02.060,
				  48.15.040(4), and
				  48.15.090(2).
				  12-04-082 (Matter No. R 2011-10), §
										284-15-030, filed 1/31/12,
				  effective 3/2/12. Statutory Authority:
				  RCW
				  48.02.060. 06-12-077 (Matter No. R 2006-04),
				  §
										284-15-030, filed 6/6/06,
				  effective 7/7/06; 81-03-082 (Order R 81-1), §
										284-15-030, filed
				  1/21/81.