Navigating the complexities of securing insurance coverage can often lead merchants and businesses through a maze of regulatory and paperwork requirements, especially when conventional insurance markets in New York do not cater to their specific needs. In such instances, the Excess Line Placement form becomes a critical document in the insurance procurement process. This form serves as a notice to parties that a portion or all of the required insurance coverages has been placed with insurers not authorized within New York, slipping beyond the purview of state supervision. Such placements are permissible under stringent conditions: either after a diligent search for coverage within authorized insurers proves futile or when the insurance in question falls under the “Export List” risk categories or is bought by an “Exempt Commercial Purchaser.” This form not only outlines the circumstances under which these placements can occur but also details the financial commitments the insured party is agreeing to. These include premiums, inspection charges, service fees inclusive of taxes, stamping fees, and potentially additional fees for services beyond commissions. It underscores the strokes of caution, informing the insured of the risks involved, notably that in the event of insolvency of the unauthorized insurer, the protections normally afforded by New York State's security fund will not be available. The document, with its rigorous disclosures, thus stands as a safeguard for both the insured and the broader regulatory environment, ensuring clarity and understanding of the financial and regulatory implications of utilizing excess line insurance placements.
| Question | Answer |
|---|---|
| Form Name | Excess Line Placement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | notice of excess line placement form edit, 2011 nelp, notice excess line placement, directions to complete the ny notice of excess lines placement form |
NOTICE OF EXCESS LINE PLACEMENT
Date:
Consistent with the requirements of the New York Insurance Law and Regulation 41
__________________________ is hereby advised that all or a portion of the required coverages have been
placed by __________________________________ with insurers not authorized to do an insurance business in
New York and which are not subject to supervision by this State. Placements with unauthorized insurers can only be made under one of the following circumstances:
a)A diligent effort was first made to place the required insurance with companies authorized in New York to write coverages of the kind requested; or
b)NO diligent effort was required because i) the coverage qualifies as an “Export List” risk, or ii) the insured qualifies as an “Exempt Commercial Purchaser.”
Policies issued by such unauthorized insurers may not be subject to all of the regulations of the Superintendent of Financial Services pertaining to policy forms. In the event of insolvency of the unauthorized insurers, losses will not be covered by any New York State security fund.
TOTAL COST FORM (NON TAX ALLOCATED PREMIUM TRANSACTION)
In consideration of your placing my insurance as described in the policy referenced below, I agree to pay the total cost below which includes all premiums, inspection charges(1) and a service fee that includes taxes,
stamping fees, and (if indicated) a fee(1) for compensation in addition to commissions received, and other expenses(1).
I further understand and agree that all fees, inspection charges and other expenses denoted by(1) are fully earned from the inception date of the policy and are
Re: Policy No. |
Insurer |
|
Policy Premium |
|
$ |
Insurer Imposed Charges: |
|
|
Policy Fees (1) |
|
$ |
Inspection Fees (1) |
|
$__________________ |
Total Taxable Charges |
|
$ |
Service Fee Charges: |
|
|
Excess Line Tax (3.60%) |
|
$ |
Stamping Fee |
|
$ |
Broker Fee (1) |
|
$ |
Inspection Fee (1) |
|
$ |
Other Expenses (specify) (1)_____________________________ |
$ ___________________ |
|
|
Total Policy Cost |
$ ___________________ |
_____________________________________
(Signature of Insured)
(1)= Fully earned
NYSID FORM: NELP/2011