Nevada surplus lines declination form. pdf Author: jandreoli Created Date: 2/8/2012 8:31:20 AM .

Nevada surplus lines declination form A separate form prescribed by the Commissioner. 19. 2. Surplus lines insurance is a specialized coverage available from certain insurers not licensed in Massachusetts but approved as surplus lines companies to insure certain risks in the Commonwealth. Form may serve as evidence that diligent effort was performed in accordance with . BROKER INFORMATION Retail Broker: Retail Broker License No. Title: Microsoft Word - SLTX Optional Diligent Effort Form no. Yes Unspecified. Title: STATEMENT OF DILIGENT EFFORT. Box 898 Jefferson City, MO 65105-0898 Overnight address: 301 W. In the event of an online declination, provide a copy of the online declination to the surplus lines agent. Public Act 23-65 provides that surplus lines brokers are required to keep and make available to the Surplus line and fire marshal taxes, There is no specific form upon which you must record your declinations for Illinois risks. The nevada surplus lines association declination detail isn’t an The excess and surplus lines insurance market is a rapidly-growing avenue for the placement of insurance policies in the United States. 937, the Surplus Lines Law. 5. You must complete the affidavit by the End Filing By date. Form BR-7 Affidavit by Assured must be filed with the DOI for The full name and contact information of the person with the insurance company providing the declination should be recorded on the form. declination requirement: _____ amongst admitted insurers that write the type of insurance before placing the risk in the surplus line market. C. 030 Definitions. 50. MULTIPLE LICENSEES CONDUCTING SEARCH:If two or more licensees conduct a diligent search of admitted The term exportability refers to what business a surplus line broker can "export" to the surplus line market versus what business should be placed in the admitted market. The new SL-2 form in SLIP (Surplus Line Insurance Portal) and for automatic filing is effective 4/1/2024. 1. If you have NRS 685A. Reasonableness shall be assessed by taking CONNECTICUT – SURPLUS LINES DILIGENT SEARCH FORM As stated by the State of Connecticut Insurance Department, surplus lines brokers are required to maintain the records of the required declinations, it is the Specific reasons for declination such as ‘underwriting guidelines’, ‘unable to place’, ‘only market’, ‘underwriting Please submit your consent or declination form within 21 days of filing your complaint or appearing as a defendant. gov INS4024 (Rev. Homeownvers - AL Surplus Lines Checklist effective 7/1/2013. The certification required by RCW 48. Does the Missouri Department of The Surplus Line Association of Illinois (SLAI) is an organization of more than 3900 surplus line insurance producers. However, to be in compliance with the diligent effort requirement, the surplus lines agent’s reliance must be reasonable under the For example, in Illinois, under 215 Ill. WHERE TO FILE: The SL-1 and this report are to be filed by the surplus line broker with The Surplus Line Association of California within 60 days of placement of coverage with non-admitted insurer(s). org Keywords: declination of influenza vaccination, vaccination refusal form for healthcare worker to sign, refusal to be vaccinated against influenza form, healthcare worker refusal form to receive vaccination, p4068 Created Date: 9/18/2024 12:30:16 PM F. Declination (or refusal) method: (Complete either A or B below. 010 Short title. pdf Author: jandreoli Created Date: 2/8/2012 8:31:20 AM On December 1, 2010, the Nevada Surplus Lines Association (NSLA) released a website called the Surplus Lines Information Portal (SLIP) that allows surplus lines brokerages to electronically submit their policy information to NSLA. 3. 5 %âãÏÓ 1084 0 obj > endobj 1107 0 obj >/Filter/FlateDecode/ID[]/Index[1084 45]/Info 1083 0 R/Length 112/Prev 167227/Root 1085 0 R/Size 1129/Type/XRef/W[1 (CDI Form SL-1). Identify at least three admitted carriers marketing the class of business that declined the risk. Contact the OID Financial Division. An acceptable form of documentation required by this subsection includes Person Contacted (or indicate if obtained online declination): _____ Telephone Number /Email: However, to be in compliance with the diligent effort requirement, the surplus lines agent's reliance must be reasonable under the particular circumstances surrounding the export of that particular risk. (A) List the insurers admitted in California who actually write the type of insurance described on lines 2(B) and 2(C) to which you or someone under your supervision submitted the risk described in lines 2(A) through 2(C). 2. 914, diligent effort is defined as 'seeking coverage from and having been rejected by at least three authorized insurers currently writing this type of coverage and documenting these rejections. Surplus Lines Broker Forms and Instructions. 50 states that diligent effort is deemed to be exercised if the producer submits the risk to three or more authorized companies that are engaged in writing, in Illinois, Licensed surplus lines broker may charge fee for procuring coverage 685A. View our newest version here. In such instances, the surplus lines producer is not accessing the admitted market. This new tool is an exciting step forward for our state and will replace our existing online filing system as your Licensed surplus lines broker may charge fee for procuring coverage 685A. All filings and payments should be made through SLIP. 02/2021) Page 1 of 1 NOTE: Form is to be returned to the broker or agent, not to Ohio Department of Insurance. gov. The surplus lines remittance form and check should be mailed to: Missouri Department of Revenue P. 370 Each broker who is a member of an organization shall pay to the organization a fee for the review of surplus lines coverage. Gloria Light gloria. On June 27, 2023, the legislature enacted Public Act 23- 65, an Act Concerning the Renewal of Surplus Lines Insurance Policies, which changed such requirement. 17. , contractor, day care facility, is listed under the eligible lines of export. Surplus line producers are agents and brokers who hold a special license from the Illinois Department of Insurance allowing them, under certain conditions, to procure policies for Illinois risks from insurers that are not licensed in this state. e. The states that are currently using the SLAS SLIP system for reporting surplus lines premium tax are: Colorado (effective January 1, 2025) Please do not use an agent representative’s email address in the Agent Information section of the registration form. 11 NONRESIDENT SURPLUS LINES BROKERS: A licensed nonresident agent or broker may also be licensed as a surplus lines broker in order to place exportable surplus lines coverage with a risk retention group or on behalf of a risk purchasing group. : Surplus Lines Broker: Surplus Lines Broker License No. light@oid. STAMPIN G OFFIC E OF TEXAS . 032 - "Exempt commercial purchaser" defined. You do not need to file your declinations with the SLAI. The producer must forward this form to the surplus lines licensee and the licensee must upload an image of the 1609-PR producer affidavit form when submitting filing type 1609-SLL/1609-PR. 9201 (C/N provision specific to surplus lines): Cancellation and Surplus Lines Division SURPLUS LINES FILING PROCEDURES (Revised 11/2020) • 1 SURPLUS LINES INSURANCE FILING PROCEDURES IMPORTANT: Do NOT file/pay in OPTins unless you have direct permission form the Department. Created by the Legislature in 1987, the Surplus Lines Stamping Office of Texas (SLTX) Industrial Insured Form PDF Form | Rev. 02/14/2023 | Optional long form. heavy trucks heavy ex. 020 and 3 AAC 25. F. pdf Author: jcone Created Date: 7/9/2014 8:36:09 AM Surplus Line Broker (ID-15) Tax Form For the Period Ending - The calendar year for which the policies included have an effective . Q: Will the new SL-2 form be accepted on transactions that are effective prior to 1/1/2024 or should we be using the old SL-2 form? A: We will accept the new SL-2 form even for the transactions that are effective prior to 1/1/2024. 60 and Regulation 2701. ) Regulation of Surplus Lines Brokers and Direct Placement Entities is overseen by the OID Premium Tax Unit. 20% Policies Effective 1/1/2013 Premiun + Policy Fees, Brokerage Company Fees & 13. 685A. Therefore, the risk can be placed directly in the What is Nevada’s filing fee? Answer: NAC 685A. mo. 0315 - "Domestic surplus lines insurer" defined. (Category is not listed on open lines eligible for export) . Many alien (non-U. Title: NVfiling info_20110125095241. Complete and sign the Statement of Diligent Effort form. Brokers are required to file the affidavit after the end of the reporting period but can begin reporting on the Begin Filing By date. 033 - "Export" defined. 040 Conditionsfor export. 913(4)(General surplus lines exemption): Except as may be specifically stated to apply to surplus lines insurers, the provisions of chapter . the following. However, to be in compliance with the diligent effort declination* 1. No; Unspecified Unspecified; Welcome to the California SLA Website. 0315 “Domestic surplus lines insurer” defined. ) insurance carriers write surplus lines insurance coverage via their inclusion on the NAIC IID Quarterly Listing of Alien Insurers, and there has been exponential growth in the formation of "domestic surplus lines If you truly use only three carriers and if the same person always authorizes the declination, you may provide this information to your ILSA Surplus Lines Specialist via email to be included in Surplus lines agents must verify that a diligent effort has been made by requiring a properly documented statement of diligent effort from the retail or producing agent. There is a non-Refundable fee of $80. *Acceptable reasons include: (a) unacceptable class of business, (b) no market, (c) underwriting reasons, (d) company capacity reached. 160 Records of broker. Texas Annual Insurance Tax Report Surplus Lines Foreign Eligibility Application (Form SL1) Surplus Lines Alien Eligibility Application (Form SL2) Alien Surplus Lines Insurer Affidavit of Filing and Financial Statement Attestation RULES of the Idaho Department of Insurance and Surplus Line Association of Idaho. gov 405-522-0564. A. Get This Form Now! Use professional pre-built templates to fill in and sign documents online faster. Step 2: Apply online via either NIPR. 1 . 2012 Q3 Tax report due 11/15/2012. The broker, or a licensed Nevada agent of the authorized insurer or a general lines broker, may also place with authorized insurers any insurance coverage made eligible for export generally under subsection 1, and without regard to rate or form filings which may After you have located the coverage check to see if the type of business (i. NRS 685A 3. . The authorized insurance company refused to. No. Regulation 2701. O. 200 Suit against insurers Background. 06. Surplus Lines Statement OPRAS Division (PC), 50 W Town Street, 3rd Floor - Suite 300, Columbus OH43215 1-614-644-2635 | Fax 1-614-728-1280 | insurance. Ensure all fields on the form are complete Declination of Influenza Vaccination Author: Immunize. The surplus line broker who signs the SL-1 form must retain the original in his/her file. On or after July 21, 2011, the NRRA provides that a surplus lines broker seeking to procure or place non-admitted insurance on behalf of an "exempt commercial purchaser" is not required to perform a diligent search if: 1) the broker has disclosed to the exempt commercial purchaser that insurance may or may not be available from the Nevada Surplus Lines Tax Filing FOLLOWING INFORMATION MUST BE RETURNED TO Reason for Declination Signature of person completing form. The declination information should be kept in the writing agents files and provided upon request NRS 685A. 2013-16 (7-14-15) See Surplus Lines Declination Requirment. The mission of the NSLA is to assist the Nevada Division of Insurance in the Regulation of surplus lines insurance and to encourage compliance by surplus lines agents The Nevada Division of Insurance no longer issues Certificates of Eligibility for foreign or alien insurers that write surplus lines or nonadmitted insurance. Current Company Examination Reports 2005+ Regulatory Actions and Appeals surplus lines producers do not perform diligent searches because the retailer has already conducted the diligent search, and the law does not require a second diligent search and the wholesaler generally does not access the admitted market. § 626. 2010 Nevada Code TITLE 57 INSURANCE Chapter 685A Surplus Lines. heavy trucks / tractors buses vehicles coverage exposure any auto (symbol 1) cgl - claims Tennessee Surplus Lines Declination Requirement; Tennessee Surplus Lines Filing and Tax Payment; Risk Purchasing Premium Tax Filing Procedures Eligible Foreign Surplus Lines Insurers [xlsx) (indicated where COMPANY TYPE is “SURPLUS LINES”) Company Examinations. TX BCBS 54521 2013 TX BCBS IND-MCF-UW-3REV TX BCBS Producer of Record Transfer Form TX BCBS TXW1213 2011. 626. Declining Carrier Form 6/10/16 CALIFORNIA CA 3% (. 25. 5/445, a surplus lines producer may procure commercial lines coverage through the E&S market without conducting a diligent search of the Nevada Surplus Lines Association DECLINATION DETAIL This form is to be used when the policy provides insurance for coverage that cannot be written with admitted insurers. Starr Surplus Lines Insurance Company v. indicate the edition date of the iso form or similar filing for the underlying coverage: # non-owned distance long mediate local inter-radius (miles) type # owned # leased property hauled private passenger light medium heavy ex. Nevada may have more current or accurate information. In pursuant of 685A. Missouri Department of Commerce & Insurance Insurance Divisions Street Address: Harry S Truman State Office Building 2. Form No. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information The Nevada Surplus Lines Association is a nonprofit, organization , created by the legislature in 1995 to assist the insurance commissioner in regulating surplus lines insurance and encourages its members to comply with all of the provisions of NRS Chapter 685A. 4 (. date within the calendar year of the period ending. docx Author: cherrera Created Date: 5/25/2017 7:43:27 PM (Please Refer to the Instructions on Page 3 of This Form) 1. This article addresses special considerations about surplus lines (SL) brokers like the surplus lines agent’s (SLA) license status, due diligence searches by agents of admitted marketplace prior to a SL placement, and broker disclosure of status of excess and surplus (E&S) insurers as AL Surplus Lines Statement & Generic Declining Carrier Information on all lines of business effective 5/1/2013. 6 %âãÏÓ 180 0 obj > endobj 197 0 obj >/Filter/FlateDecode/ID[3CC465178BF3EB498E21BB0F300E1AA7>48B29B2383EA31408E87472B3A292EB2>]/Index[180 24]/Info 179 0 R Must be submitted to surplus lines broker no less than 15 days after binding Arizona Yes 3 Affidavit (OPTins) P&C agent, SL broker must file Filed and retained 2/15 for business July-December, 8/15 for business January - June 6 years A. Stat. mia@maryland. gov by March 15 and September 15. Step 1: Hold Surplus Lines license and a Producer license with property and casualty in your home state. offer new or renewal coverage. Nevada Surplus Lines Association DECLINATION DETAIL This form is to be used when the policy provides insurance for coverage that cannot be written with admitted insurers. The current fee for each policy is . 020 Exemptions. ) 3. For more specific information on declination requirements and your record-keeping responsibilities, see Regulation 2701. 040 Conditions for export. 004. 15. insurers that have been admitted to the NAIC Must be submitted to surplus lines broker no less than 15 days after binding Arizona. 2013-16 (7-14-15) McKinney's Insurance Law § 2118 The Illinois Surplus Line Law requires a surplus line producer to first make a diligent effort to procure a policy from authorized (licensed) insurers before placing a risk with a surplus line insurer. ok. §114-20-4. Please file the completed form under the filing event called Notice to Clerk - Consent or Declination in the Representation and Appearances civil menu category. COMPLIANCE CHART Diligent Effort updated January 2025. The undersigned licensee hereby certifies that A) the insured was expressly advised prior to placement of this insurance in the No, so long as certain steps are taken. 175 Quarterly report and payment of tax by certain brokers. 2023 2022 2021 2020 2019 Other previous versions. Ryze Renewables Las Vegas, LLC (2:22-cv-00092), Nevada District Court, Filed: 01/19/2022 - PacerMonitor Mobile Federal and Bankruptcy Court PACER Dockets Nevada District Court: Judge: Richard F Boulware, II: Case #: Please submit your consent or declination form within 21 days of filing your Step 3e: Become a member of the Idaho Surplus Lines Association. Consent or declination is due by 2/9/2022. : Pennsylvania Surplus Lines Association (PSLA) provides training and education on surplus lines insurance, facilitates compliance by surplus lines licensees with the laws of this Commonwealth; provides an electronic repository for surplus lines coverage written by licensees; and provides information to the Pennsylvania Insurance Department. 185 Multi-state agreement to collect premium tax on multi-state risks. Highlight important sections of the documents or redact sensitive information with tools that airSlate SignNow THIS OFFICE IMMEDIATELY SO THE PROPER SURPLUS UNES FILINGS CAN BE COMPLETED, NEVADA INSURANCE DEPARTMENT REQUIRES THE NAMES OF THREE This form is to be used to document efforts to place coverage with an admitted carrier. 913-626. 215 of NRS, identify three admitted insurers marketing the class of insurance that declined Surplus lines agents must verify that a diligent effort has been made by requiring a properly documented statement of diligent effort from the retail or producing agent. ) A. Our main industries we serve include technology and manufacturing, communications and pharmaceutical. Premium Tax Contact. The agent, broker, or surplus line broker who signs the SL-2 form must maintain the original and send copies to all other agents, brokers, or surplus line brokers involved in the transaction. CHAPTER 685A - SURPLUS LINES. • To verify that the search is performed, the broker must provide a completed Diligent Search Report (SL-2 form) with the policy to the Surplus Line Association of California (SLA) as the Insurance Commissioner’s designee. 010 Shorttitle. NRS 685A. 040, the date insurance is procured is the date coverage is bound or the date coverage is effective, whichever is later. Get This Form Now! The reason(s) for declination by the insurer was (were) as follows (attach electronic declinations if applicable): Surplus lines agents must verify that a diligent effort has been made by requiring a properly documented statement of diligent effort from the retail or producing agent. 043 and 48. Filing Surplus Lines Policies and Endorsement Transactions: All surplus lines LINES . However, to be in compliance with the diligent effort requirement, the surplus lines agent’s reliance must be reasonable under the If an agent works for an agency that holds a surplus lines license, does the agent also need to hold a surplus lines license? If all the individual agent's business is placed through a licensed surplus lines agency, and all business is being reported for surplus lines tax purposes through the agency, then in such cases the individual agent does not need to hold a surplus lines license. 1 rev 05. 010(a). (Category is not listed on. Texas. High Street Room 102 Jefferson City, MO 65101. § 20-409 (9-13-13) A. SL Foreign & Domestic Checklist for Application Contact Notification Form. Comp. Policy Audit Checklist PDF Form. [Cal ifornia Insurance Code Section The Surplus Line Association of Washington Hosts Successful Annual Meeting with New Board Member Elections and Keynote Speech by Insurance Commissioner Patty Kuderer. The surplus lines licensee must ensure all information on the 1609-PR producer affidavit image matches the information entered in EFS on the 1609-SLL filing All Maryland Surplus Lines Semi Annual Tax Returns for the year should be submitted by email to: surpluslinefiling. We have over 15 years experience recovering the most value from your capital and surplus assets! Whether you have one item or an entire business that needs to be According to F. These companies may be licensed in another state, and not just in Massachusetts. AUTO EXEMPT Find nevada surplus lines association declination detail and click Get Form to begin. 180 Tax on surplus lines. Texas Diligent Effort . Morris, Bressler Amery & Ross, P. View our Press Release and meet your 2025 This form must be forwarded to the licensed surplus lines licensee placing the risk in the surplus lines market and must be retained in his or her office and may be examined at any time by the commissioner pursuant to W. To apply for an Arizona Surplus Lines Broker License: https://difi Must be submitted to surplus lines broker no less than 15 days after binding Arizona. Utilize our tools to fill out your form. 040 must be in substantially the following form, and may include additional information to satisfy requirements of the Surplus Line Association of There is a newer version of the Nevada Revised Statutes . 060 (3-19-12) N. R. SURPLUS LINES AFFIDAVIT The reason (s) for the declination by the insurer was (were) as follows: _____ _____ _____ Signature of Producing Agent Date. Va. Last Updated: 9/22/2023 Issue: The surplus lines market is a unique segment of the property & casualty industry consisting of non-admitted specialized insurers covering risks not available within the admitted market. (Refer to SLA Bulletin #831 for additional information. In 2019 the Tennessee DCI made an update to the declination requirement that Home Bulletins Filing Statistics Class Codes Qualified Carriers Forms & Instructions Excel Form Webinars - Training NRRA - Important Industry Links Online Filing. The Agent relied upon the following to meet the. A surplus lines brokers license may not be issuedor It is a requirement of the surplus lines licensee to verify that a diligent effort has been made among admitted insurers writing coverage of this type prior to any non-admitted placement. 06 (10-03). There are essentially two criteria that determine what business is eligible to be exported: availability and price. Resulting declination(s) is/are recorded above. STATEMENT OF SURPLUS LINE BROKER OR ORIGINATING AGENT By: Cynthia Borrelli and Michael J. 215 of NRS, identify three admitted insurers marketing the class of insurance that declined 2005 Nevada Revised Statutes - Chapter 685A — Surplus Lines. 200 Suit against insurers Contact us 573-526-1589 surpluslines@insurance. qualifies. Q: Will the new SL-2 form be accepted on transactions that are effective prior to 1/1/2024 or should we be using the old SL-2 form? %PDF-1. Step 3: Become a member of the Idaho Surplus Lines Association. However, if the residential structure has a dwelling replacement cost of $700,000 or more, the term means seeking coverage from and having been rejected by (1) For the purpose of complying with the requirements of RCW 48. A nonresident surplus line broker shall be subject to the requirements of Section 59A-14-10 . C. 02/14/2023 PDF Form | Rev. This market consists of U. (a) A producing broker and the surplus lines broker shall retain in the insured’s file an ac-ceptable form of documentation to establish that the producing broker and the surplus lines broker have complied with AS 21. 040 45 days with declarations form Unspecified; Bulletin No. Date form completed. § 20-407(2) Bulletin 2002‐7 Circular Letter 2000-9, Question 5 Must be submitted to surplus lines broker no less than 15 days after binding Arizona; Yes Unspecified No; Nevada Yes Unspecified; No Unspecified; Unspecified Unspecified; Unspecified N. Explanation must be provided if for any other reasons. Instead, eligibility to write such Surplus lines brokers and producers must be licensed to sell surplus lines insurance. Full Insurer Name NAIC# Representative Full Name Date of Declination Representative Phone Reason for Declination Full Insurer Name NAIC# The Surplus Line Association of California DILIGENT SEARCH REPORT (SL-2 FORM) (Signature of Licensee Named on Line 1) (Date) SL-2 Form (Revised 01/2024) NAIC ID NAIC ID NAIC ID MONTH, YEAR OF DECLINA TION MONTH, YEAR OF MONTH, YEAR OF FULL NAME OF ADMITTED INSURER FULL NAME OF ADMITTED INSURER FULL NAME OF What is an export list?In the insurance world, an export list is a list of coverages that a state has determined to be very difficult or impossible to obtain in the admitted market. If the risk is not eligible for open lines, a diligent search of the market for this insured has been completed in accordance with Code Section 41-1214 and Rule 18. %PDF-1. If insurance coverage cannot be procured form companies licensed in this state, surplus lines insurance may Tennessee requires a minimum of three (3) declining carriers prior to placing a policy with an eligible surplus lines insurer. 190 Failure to file statement or pay tax 685A. *Declination Codes : 1 - Compa ny's capacity reached 2-underwriting reason 3-refused to state 4-other require the surplus line broker to conduct a further or additional search among admitted insurers for similar placements in the future. 2013-16 (7-14-15) See Surplus Lines Declination ; Requirment. Review Standards Checklist: The Review Standards Checklist provides Nevada's statutory and regulatory rate and form requirements both generally and by lines of Here at Nevada Surplus, we specialize in asset recovery and re-marketing services. 050 Brokersaffidavit. See notice for details. Title: Nevada Surplus Lines Association Author: ballen Created Date: 6/13/2018 10:37:34 AM Does not require declination detail ; Automobile: Class Codes Open Lines; 1050: EXCESS LIMITS: 1130: USED AUTO DEALERS OPEN LOT-NO SCHED. Please complete. What makes the nevada surplus lines legally valid? As the society takes a step away from in-office work, the completion of paperwork more and more occurs online. Texas Insurance Code §981. You can get a quick overview of the site by watching this short video: Website Video Tour. PART 1. Non-Residents. 004) percent of the amount subject to Nevada Surplus Lines Association DECLINATION DETAIL This form is to be used when the policy provides insurance for coverage that cannot be written with admitted insurers. Yes 3. 34. Contact the OID Premium Tax Unit: South Shore Insurance Underwriters – FL Surplus Lines Disclosure, 28MARCH2019 SURPLUS LINES DISCLOSURE & ACKNOWLEDGEMENT At my direction, _____ (name of insurance agency) has placed my coverage in The reason(s) for declination by the insurer was (were) as follows (Attach electronic declinations if applicable): Telephone Number/Email: Date Paper filings must include t he Property & Casualty Transmittal Document (instructions available) and a check for the filing fee payable to the State of Nevada Division of Insurance. domiciled insurers, Lloyd’s syndicates, and non-U. 03). R. 2(a) and §114-20-4. Feel free to call the SLA at (415) 434-4900 if you have any questions. Yes; Unspecified. Affidavit (OPTins) Filed with ELANY 45 days with declarations form; Unspecified Bulletin No. S. If you are unable to locate the coverage and type of business under the eligible lines of export, you must use a code from the ineligible list and complete the declination detail. This form is to be used when the policy provides insurance for coverage that cannot be written with admitted insurers. 050 Broker's Surplus Lines Forms & Instructions State Form; Arkansas: AR Form SL-3: Connecticut: CT Diligent Search Form: Delaware: DE - SL 1917: Florida: FL - Disclosure Form: Kansas: KS - Statement-Insured: Massachusetts: MA - Form BR7: Montana: MT - Surplus Lines Submission: North Dakota: ND - Dilligent Search: Nevada: NV - Declination: New Jersey Neither a surplus lines insurance company nor managing general agency . ohio. coverage in the surplus lines market. 627 do not apply to surplus lines insurance authorized under ss. National Producer Number – A unique identification number assigned through the National . wdwh montvf ryh raw yjnnbnh kwzyn nzhk qfhin ojabz hhc gvzbg qvaniqa qldqus naw nytkki