SL2 - Diligent Search Report
SL-2 (Revised 06/2004)
(Please Refer to the Instructions on Page 3 of This Form)

1.

hereby submits that he/she is:

 

(A)

Duly licensed under ;

OR

(B)

,
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)

 

(B)

 

 

 

,

 

(C)

 

(D)

 

 

 

,

 

(E)

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?

(CHECK ONE)

YES   NO

 

(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)?

(CHECK ONE)

YES   NO

 

(C)

If YES, has this risk been submitted to and found to be ineligible by CAARP?

(CHECK ONE)

YES   NO

 

 

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?

(CHECK ONE)

YES   NO  

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)

6.

(A)

 

(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)?

(CHECK ONE)

YES   NO

 

(B)

If YES, please complete ALL sections of the following table; if NO, skip to Section 8:
1) Full name of Admitted Company

First And Last Name of Company Representative
Telephone Number of Company Representative
() - ext.

Check if Employee (E) or Agent (A)

Month, Year of Declination

Declination Code*

E
A


or "Online Declination" Website

2) Full name of Admitted Company

First And Last Name of Company Representative
Telephone Number of Company Representative
() - ext.

Check if Employee (E) or Agent (A)

Month, Year of Declination

Declination Code*

E
A


or "Online Declination" Website

3) Full name of Admitted Company

First And Last Name of Company Representative
Telephone Number of Company Representative
() - ext.

Check if Employee (E) or Agent (A)

Month, Year of Declination

Declination Code*

E
A


or "Online Declination" Website

*Declination Codes:  1 - company's capacity reached  2 - underwriting reason 3 - refused to state  4 - other

 

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)? (CHECK ONE) YES   NO

 

(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 non-admitted
insurer for the sole purpose of securing a rate or premium lower than the lowest rate or premium available from an
admitted insurer.
   
Date (Signature of Licensee Named on Line 1)