default namespace = "http://ws.slacal.org/schema/sl2/2007/10/15" ## ## This represents the XML version of the SL-2 Form: ## DILIGENT SEARCH REPORT ## It is based on the revision from 06/2004 ## sl2form = element sl2form { ## Section 0: Please check ONE box only: ## For XML please include the corresponding tag for each checkbox ( ## Section 0.a: ## "The following information, accompanied by a copy of the ## declarations page or certificate or binder, is submitted ## for an insurance coverage or risk listed on the current ## California Department of Insurance Export List. ## (Calfornia Insurance Code Section 1763.1)" element Coverage_on_Export_List { empty } | ## Section 0.b: ## "The following information, accompanied by a copy of the ## declarations page or certificate or binder, and a fully ## executed copy of the diligent search report (SL-2 Form), ## is submitted in accordance with California Insurance Code ## Section 1763(a)." element Diligent_Search_Report { empty } )?, ## Section 1: Please enter the name of the Broker element Broker_Name { text }, ## "hereby submits that he/she is:" (( ## Section 1(A): ## "a duly licensed surplus line broker, license number" element Broker_License_Number { text } ) | ## or, ( ## Section 1(B): ## "a transactor on the surplus line license of" element Brokerage_Name { text }, # Name of Organization ## Section 1(C): element Brokerage_License_Number { text } # License Number ))?, ## "and, that he/she or said organizational licensee was engaged by ## the insured, or the insured's broker, named herein, to obtain ## insurance against certain risk as described in this report." ## Section 2: "Risk Description" ## Section 2(A): "Name of Insured" ## Please list all names. If there is a primary insured name it should ## be listed first. element Insured_Name { text }*, ## Section 2(B): "Address of Insured" ## Multiple addresses can be provided (if applicable), however primary ## insured's address should be listed first. element Insured_Address { address }*, ## Section 2(C): "Description of the Risk ## (e.g. Laundramat, Liqor Store, - NOT TYPE OF COVERAGE)" element Risk_Description { text }*, ## Section 2(D): "Location of Risk" ## Multiple addresses can be provided (if applicable). element Risk_Address { address }*, ## Section 2(E): "Export List Code or Coverage Code" ## Multiple export/coverage codes can be provided if applicable. element Export_or_Coverage_Code { xsd:integer }*, ## Section 3 "If Private Passenger Automobile Liability Insurance ## is identified on line 2(E), complete the following:" ## Section 3(A): "Does the insured qualify as a 'Good Driver' under ## Section 1861.025 of the California Insurance Code? (Check One)" ( element Good_Driver_YES { empty } | element Good_Driver_NO { empty } )?, ## Section 3(B): "Does the coverage that you have placed include, ## in whole or in part, the limits of coverage provided under the ## California Automobile Assigned Risk Plan (CAARP)? (Check One)" ( element CAARP_Coverage_Included_YES { empty } | element CAARP_Coverage_Included_NO { empty } )?, ## Section 3(C): "If YES, has this risk been submitted to and found ## to be ineligible by CAARP? (Check One)" ( element CAARP_Ineligible_YES { empty } | element CAARP_Ineligible_NO { empty } )?, ## Section 4: "If Health Insurance is identified on line 2(E), does ## the insured qualify as a 'Small Employer' under Section 10700(x) ## of the California Insurance Code? (Check One)" ( element Small_Employer_YES { empty } | element Small_Employer_NO { empty } )?, ## Section 5: "If this insurance was placed pursuant to Section ## 125 et seq. of the California Insurance Code governing transactions ## with Risk Purchasing Groups authorized by the Federal Liability ## Risk Retention Act of 1986, complete the following:" ## Section 5(A): "Provide the name and address of the purchasing ## group of which the insured is a member" ( ## Name of the Risk Purchasing Group element RPG_Name { text }, ## Address of the Risk Purchasing Group element RPG_Address { address }? )?, ## Section 6(A): "Describe the diligent efforts made to place this ## coverage with admitted insurers and describe how the search was ## performed (please add additional pages if necessary):" element Efforts_Performed { text }*, ## Section 6(B): "If search was performed by someone other than the ## person named on line 1, please provide the full name of that ## individual:" element Search_Performed_By { text }?, ## Section 7(A): "Was the risk described in Section 2 submitted by ## you or someone under your supervision to at least (3) insurers ## that are admitted in California and who actually write the type ## of insurance described on lines 2(C) and 2(E)? (Check One)" ( element Submitted_to_3_Admitted_Insurers_YES { empty } | element Submitted_to_3_Admitted_Insurers_NO { empty } )?, ## Section 7(B): "If YES, please complete ALL sections of the following ## table; if NO, skip to Section 8:" element Admitted_Company { ## Full Name of Admitted Company element Insurance_Company { text }?, element NAIC_Number { text }?, ## First & Last Name of Company Representative element Company_Representative { text }?, ## Telephone Number "( ) - " element Telephone_Number { text }?, ## or Online Declination Website element Website { text }?, ## Check if Employee (E) or Agent (A) ( element Representative_is_Employee { empty } | element Representative_is_Agent { empty } )?, ## Month, Year of Declination "MM/YYYY" element Declination_Date { text }?, ## Declination Code ## 1 - Company's capacity reached ## 2 - underwriting reason ## 3 - refused to state ## 4 - other element Declination_Code { xsd:integer }? }*, ## Section 8: "If 7(A) was answered NO, complete the following:" ## Section 8(A): "Did you determine that fewer than 3 admitted insurers ## actually write the type of insurance described on lines 2(C) and ## 2(E)? (Check One)" ( element Fewer_than_3_Insurers_YES { empty } | element Fewer_than_3_Insurers_NO { empty } )?, ## Section 8(B): "If NO, please explain in detail why the risk was ## submitted to less than three admitted insurers in California that ## write this type of insurance." element Less_than_3_Explanation { text }*, ## Section 8(C): "If YES, please describe how you made this ## determination." element Less_than_3_Determination { text }*, ## Trailer ## "Date" the original SL-2 Form was signed by the person named in ## section 1. element Date_Signed { text }? } ## address = element address { ## One or more lines of address information element Address { text }+, ## Name of the city element City { text }?, ## State or Province ## For US and Canada please use official 2 character code ## For all other countries (were applicable) please use the full name element State_or_Province { text }?, ## Postal/ZIP Code ## For US use ZIP+4 (5 digits, hyphen, 4 digits) or just 5 digit code. ## For other countries enter postal code in the appropriate format. ## In some countries the space between parts of the postal code is ## significant and should not be omitted. element Postal_Code { text }?, ## Country Name element Country { text }? }