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Division of Insurance Diligent Effort Affidavit STATE OF COLORADO (Name of Licensed Producer) declares he/she is the holder of a current Colorado Producer s License Number. The policy appearing on

How to fill out colorado surplus lines affidavit

How to fill out Colorado surplus lines affidavit:

1. Obtain the form: The Colorado surplus lines affidavit can be obtained from the Colorado Division of Insurance website or from your insurance broker.
2. Provide company information: Fill in the name, address, and contact details of the surplus lines insurance company issuing the policy.
3. Indicate insured information: Enter the name, address, and contact details of the insured party or parties covered under the policy.
4. Specify policy details: Provide information about the surplus lines policy, including the policy number, effective dates, and coverage limits.
5. Describe the insured risk: Clearly describe the nature of the risk being insured, including any applicable industries or activities.
6. Attach supporting documents: Include any necessary supporting documents, such as certificates of insurance or policy endorsements.
7. Sign and date: The surplus lines affidavit must be signed and dated by an authorized representative of the surplus lines insurance company.
8. Submit the affidavit: Once completed, the affidavit should be submitted to the Colorado Division of Insurance.

Who needs the Colorado surplus lines affidavit:

The Colorado surplus lines affidavit is typically required by insurance brokers and surplus lines insurance companies conducting business in the state. It is necessary for them to comply with Colorado insurance laws and regulations regarding surplus lines coverage. Clients or insured parties may also be requested to provide information for the filing of this affidavit in some cases, but the primary responsibility lies with the insurance professionals involved in the placement of surplus lines policies.

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What is colorado surplus lines affidavit?

The Colorado surplus lines affidavit is a form that must be filed by insurance producers who wish to place insurance coverage with non-admitted insurance companies in Colorado.

Who is required to file colorado surplus lines affidavit?

Insurance producers are required to file the Colorado surplus lines affidavit.

How to fill out colorado surplus lines affidavit?

The Colorado surplus lines affidavit can be filled out by providing information about the insured, the insurance coverage being placed, and the non-admitted insurance company.

What is the purpose of colorado surplus lines affidavit?

The purpose of the Colorado surplus lines affidavit is to ensure that proper documentation is in place for insurance coverage that is being placed with non-admitted insurance companies.

What information must be reported on colorado surplus lines affidavit?

Information such as the insured's name, the type of coverage being placed, the name of the non-admitted insurance company, and the amount of coverage must be reported on the Colorado surplus lines affidavit.

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