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SL-2 Form

Diligent Search Report

1.
hereby submits that he/she is:
(A) Duly licensed under California Department of Insurance license number
;
OR
(B) Duly licensed and authorized to act as an endorsee on the organizational license of
, California Department of Insurance license number
; and
(C) that he/she or said organizational licensee was engaged by the insured named herein, or the insured's broker, to obtain insurance as described in this report; and
(D) is the licensee who performed or supervised this diligent search.

2.
(A) Name of Insured
(B) Address of Insured
(C) Description of the Risk
(D) Location of Risk
(E) Type of Insurance coverage

3.
If Private Passenger Automobile Liability Insurance is identified on line 2(E), complete the following:
(A) Does the insured qualify as a "Good Driver" under Section 1861.025 of the California Insurance Code?
(B) Does the coverage that you have placed include, in whole or in part, the limits of coverage provided under the California Automobile Assigned Risk Plan (CAARP)?
(C) If YES, has this risk been submitted to and found to be ineligible by CAARP?
If your answer is NO, then this coverage cannot be placed with a non-admitted insurer. (See Insurance Code section 1763.5)

4.
If Health Insurance is identified on line 2(E), does the insured qualify as a "Small Employer" under Section 10700(x) of the California Insurance Code?

5.
If this insurance was placed pursuant to Section 125 et seq. of the California Insurance Code governing transactions with risk purchasing groups authorized by the Federal Liability Risk Retention Act of 1986, complete the following:
(A) Provide the name and address of the purchasing group of which the insured is a member

6.
(A) Describe the diligent efforts made to place this coverage with admitted insurers and describe how the search was performed (please add additional pages if necessary):
(B) If search was performed by someone other than the person named on line 1, please provide full name of that individual:

7.
(A) Was the risk described in Section 2 submitted by you or by someone under your supervision to at least (3) insurers that are admitted in California and who actually write the type of insurance described on lines 2(C) and 2(E)?
(B) If YES, please complete ALL sections of the following table; if NO, skip to Section 8:

Admitted Insurer 1

Full Name of Admitted Company (NAIC #)

First & Last Name of Company Representative
Telephone Number
(
)
-
ext.
 
or “Online Declination” Website

Month, Year of Declination
/
Declination Code

Admitted Insurer 2

Full Name of Admitted Company (NAIC #)

First & Last Name of Company Representative
Telephone Number
(
)
-
ext.
 
or “Online Declination” Website

Month, Year of Declination
/
Declination Code

Admitted Insurer 3

Full Name of Admitted Company (NAIC #)

First & Last Name of Company Representative
Telephone Number
(
)
-
ext.
 
or “Online Declination” Website

Month, Year of Declination
/
Declination Code

8.
If 7(A) was answered NO, complete the following:
(A) Did you determine that fewer than 3 admitted insurers actually write the type of insurance described on lines 2(C) and 2(E)?
(B) If NO, please explain in detail why the risk was submitted to less than three admitted insurers in California that write this type of insurance.
(C) If YES, please describe how you made this determination.
The undersigned licensee hereby certifies that this report is true and correct, and that this risk is not being placed with a nonadmitted insurer for the sole purpose of securing a rate or premium lower than the lowest rate or premium available from an admitted insurer.