SL2

SL2 - Diligent Search Report

SL-2 (Revised 06/2004)

(Please Refer to the Instructions on Page 3 of This Form)

hereby submits that he/she is:

(A)

Duly licensed under California Department of Insurance license number ;

(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.

(A)

Name of Insured

(B)

Address of Insured

(C)

Description of the Risk

(D)

Location of the Risk

(E)

Type of Insurance coverage

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)

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

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

(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:

(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