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| COMMONWEALTH
OF PENNSYLVANIA INSURANCE DEPARTMENT |
| 1609-PR |
(must be included
with 1609-SLL/1609-PR)![]() |
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Report of trasactions with
unlicensed insurer(s) in accordance with Section 1609 of Article XVI,
Surplus Lines of the Insurance Company Law, Act of May 17, 1921, P.L. 682,
No. 284, as amended |
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DECLARATION BY PRODUCER |
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I declare under the penalties provided for
perjury, that I have made a diligent effort to procure the insurance
coverage described above from licensed insurers which are authorized to
transact the kind of insurance involved and which provide, in the usual
course of business, coverage comparable to the coverage being sought and
have been unable to procure said insurance. Among the licensed insurers
declining to insure the risk or declining the amount of insurance on this
risk, are the following: |
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I further declare under the penalties provided for perjury, that
at the time of presenting a quotation to the insured, the insured was
given notice in writing, either directly or through the producer,
that:
The insurer with whome the insurance is to be placed is not
admitted to transact business in this Commonwealth and is subject to
limited regulation by the Department; and in the event of the insolvency
of the insurer, losses will not be paid by the Pennsylvania Property and
Casualty Insurance Guaranty Association.
ALL applicable provisions of ARTICLE XVI of the Insurance
Company Law (40 P.S. §991.1601 et seq.) and
Title 31 PA Code, Chapter 124 have been or will be complied
with. |
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