Specialty

California SL-2 — Diligent Search Report

California surplus lines diligent search report — documents the admitted insurers contacted and declined before a risk is placed with a non-admitted carrier.

Your agency information

This filing is completed by the licensed retail agent/broker — your details below are required and appear as the retail agent on the report.

Agency name *

Agent first name *

Agent last name *

Agent email *

Agent phone

Agency street address

Agency city

Agency state

Agency ZIP

Risk

Name of insured *

Description of risk *

e.g., Tattoo Parlor, Cannabis Dispensary, Vacant Building — NOT the type of coverage

Type of insurance or coverage code

Optional — enter the SLA coverage code or the coverage name. e.g., 300 = General Liability.

Email address

Phone

Description of operations

What the business actually does, in a sentence or two. This is printed on the ACORD 125.

Licensee (Line 1)

Your full name (as the licensee performing the diligent search) *

Are you signing as an individual or as an endorsee on an organization? *

Admitted Insurers Contacted

List the three admitted insurers you (or someone you supervised) contacted who declined the risk — all three are required, each with a website.

Insurer 1 — full name (search the admitted-carrier list) *

Insurer 1 NAIC # (optional — auto-filled from the carrier you pick)

Leave blank unless you typed a carrier that isn't in the list.

Insurer 1 — month & year of declination *

Insurer 1 — full name of your contact

Defaults to 'Website' (you'll give the underwriting website below). Or replace it with the full name of who you contacted, or 'Phone Underwriter'.

Insurer 1 — phone, email, or website *

Enter the insurer's underwriting/appetite WEBSITE here (recommended) — or a phone or email. A website is placed in the Website box automatically; a phone/email goes in the Phone/Email box.

Insurer 2 — full name (search the admitted-carrier list) *

Insurer 2 NAIC # (optional — auto-filled from the carrier you pick)

Leave blank unless you typed a carrier that isn't in the list.

Insurer 2 — month & year of declination *

Insurer 2 — full name of your contact

Defaults to 'Website' (you'll give the underwriting website below). Or replace it with the full name of who you contacted, or 'Phone Underwriter'.

Insurer 2 — phone, email, or website *

Enter the insurer's underwriting/appetite WEBSITE here (recommended) — or a phone or email. A website is placed in the Website box automatically; a phone/email goes in the Phone/Email box.

Insurer 3 — full name (search the admitted-carrier list) *

Insurer 3 NAIC # (optional — auto-filled from the carrier you pick)

Leave blank unless you typed a carrier that isn't in the list.

Insurer 3 — month & year of declination *

Insurer 3 — full name of your contact

Defaults to 'Website' (you'll give the underwriting website below). Or replace it with the full name of who you contacted, or 'Phone Underwriter'.

Insurer 3 — phone, email, or website *

Enter the insurer's underwriting/appetite WEBSITE here (recommended) — or a phone or email. A website is placed in the Website box automatically; a phone/email goes in the Phone/Email box.

Diligent Search

Did you contact at least three admitted insurers that write this coverage? *

Line 4

Is the coverage private passenger automobile liability or health? *

If yes, the SL-2 Addendum is also required.

Certification & E-signature

I certify this report is true and correct, and that this risk is not being placed with a non-admitted insurer solely to secure a rate or premium lower than the lowest available from an admitted insurer. *

Submitting acts as your electronic signature; it is time-stamped on the SL-2.

16 questions still need an answer.

Completing this application does not bind coverage.

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