Get Excess Lines Association Aff C & Total Cost Form - Nys ... - Hr Keller & Co.

This guide will help you navigate the Excess Lines Association Aff C & Total Cost Form - Nys ... - HR Keller & Co. online. By following these clear instructions, you will be able to complete the form efficiently and accurately.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by filling in the Producing Broker Information section. Enter the Affidavit number, license number, and the broker's name, address, city, state, and zip code.
3. In the Risk Information section, provide the exact name of the insured. Ensure that it matches the name listed on the declarations page, binder, cover note, or confirmation of coverage.
4. Answer the Disclosure Information question. Indicate whether you personally provided a written Notice of Excess Line Placement to the insured as required by New York Insurance Law. Select 'Yes' or 'No'.
5. For the Declination Information section, answer the first question regarding whether the Superintendent determined that declinations are not required for this type of risk. If 'Yes', skip to the Affirmation section.
6. If you answered 'No' to the previous question, continue to the second question and specify if the insured qualifies as an 'Exempt Commercial Purchaser'. If 'Yes', skip the next question.
7. If applicable, respond to the final question regarding whether the risk was submitted to authorized companies and provide the necessary details about any companies that declined the risk, including names, NAIC codes, and reasons for declination.
8. Complete the Affirmation section by entering your name and signature, affirming the accuracy of the information provided.
9. In the Total Cost Form, fill in the policy number, insurer details, policy premium, inspection charges, service fees, and any other expenses related to the policy.
10. After ensuring all sections are filled out correctly, save your changes, and then proceed to download, print, or share the completed form as needed.

Complete your documents online now to streamline your filing process.