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Surplus line brokers' form to be filed—Contract statement to be used.
(1) For the purpose of complying with the requirements of RCW 48.15.043
, 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:
any policy fee:
Name and license number of filing Surplus Line Broker:
Name and address of referring insurance producer (if any):
Name(s) of unauthorized insurer(s):
Name and address of insured:
Binding or effective date, whichever is later:
Brief statement of coverages (common trade terms may be used, e.g. "furrier's block"):
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
(4), and 48.15.090
(2). WSR 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
. WSR 06-12-077 (Matter No. R 2006-04), § 284-15-030, filed 6/6/06, effective 7/7/06; WSR 81-03-082 (Order R 81-1), § 284-15-030, filed 1/21/81.]