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§ 2194.16. Forms.

10 CA ADC § 2194.16BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS

Barclays Official California Code of Regulations Currentness
Title 10. Investment
Chapter 5. Insurance Commissioner
Subchapter 1. Production of Insurance
Article 12. Self-Service Storage Agent Licensing Regulations
10 CCR § 2194.16
§ 2194.16. Forms.
The following information is required to be filed with the Commissioner by license applicants and licensees:
(a) Form 441-9 for individuals.
NOTICE: INFORMATION COLLECTION AND ACCESS
Section 1798.17 of the California Civil Code requires the following information to be provided when collecting information from individuals to determine compliance with the group and corporate practice provisions of the law, and to establish positive identification, to match the names of the certified list provided by the Department of Child Support Services to applicants and licensees, and of responding to requests for this information made by child support agencies.
AGENCY:Department of Insurance ADDRESS:320 Capitol Mall, Sacramento, CA 95814-4309 TELEPHONE NUMBER:(800) 967-9331 or (916) 322-3555
TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE:Chief, Producer Licensing Bureau
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION:California Insurance Code, Chapters 5, 6, 7, 8-Part 2, Division 1
THE CONSEQUENCES, IF ANY, OF NOT PROVIDING ALL OR PART OF THE REQUESTED INFORMATION:It is mandatory that you provide all information requested. Omission of any item of requested information will result in the application being rejected as incomplete.
THE PRINCIPAL PURPOSE(S) FOR WHICH THE INFORMATION IS TO BE USED:The information requested will be used to determine qualifications for licensure or certification, to determine compliance with the group and corporate practice provisions of the law and to establish positive identification.
EACH INDIVIDUAL HAS THE RIGHT TO REVIEW OWN PERSONAL FILES MAINTAINED BY THE AGENCY SUBJECT TO ANY LIMITATIONS UNDER THE INFORMATION PRACTICES ACT OF 1977, CIVIL CODE SECTION 1798.40, AND EXEMPTIONS UNDER THE CALIFORNIA PUBLIC RECORDS ACT, GOVERNMENT CODE SECTION 6254.
INSTRUCTIONS FOR COMPLETING APPLICATION
RE: “LICENSE TYPE”a separate application is required for each license type requested
RE: “APPLICANT NAME”Enter full legal name. If no middle name, enter (NMN). If any part of your legal name is an initial only, place parentheses around such initial.
RE: “ADDRESS INFORMATION”Do not enter the word “same” in any address area. Enter the appropriate address. P. O. BOX isnotacceptable for a resident or business address. Business and mailing addresses are public record and are available to the public.It is the applicants/licensees responsibility to notify the department of any change in address.
RE: “ARE YOU A CITIZEN OF THE UNITED STATES”If no is answered, the applicant must supply a copy of both sides of the work authorization.
RE: “EXAM INFORMATION”Examinations are administered daily, Monday through Friday at 8:30 a.m. and 1:00 p.m., in Los Angeles (LA), San Diego (SD), San Francisco (SF) and Sacramento (SA). An examination is also administered twice monthly in Clovis usually the second and fourth Saturday of the month at 8:30 a.m. If you fail to appear for a scheduled examination, an additional examination fee will be required for rescheduling.
RE: “PREVIOUS LICENSE HISTORY INFORMATION”If currently licensed as a resident in another state, upon becoming a California resident, a clearance letter from the previous state of residence is also required.
RE: “AKA/ALIAS”List previously and currently used aliases and maiden names, if any. If you are currently using an “also known as” (AKA) name which you desire to be noted on record, so state. Abbreviations of true name or “nick” names are not acceptable.
RE: “BACKGROUND QUESTIONS”If you answer yes to any of these questions, you must submit a signed statement, with your original signature summarizing the details of each event. You must also provide the additional certified documentation described with each question.
PRELICENSING EDUCATION REQUIREMENTS: Effective 1/1/92 all new applicants must:
A) take an approved minimum 40-hour class for the fire and casualty broker-agent license exam, and/or;
B) take an approved minimum 40-hour class for the life agent license exam, and/or;
C) take an approved minimum 20-hour class for the personal lines broker-agent license exam,
D) and take an approved minimum 12-hour class on ethics and the California Insurance Code. An applicant will be taking either 52 hours (40 and 12) or 92 hours (40 and 40 and 12) of prelicensing class hours depending on whether one or both licenses are being sought. The Personal Lines Broker-Agent applicant is required to complete 32 hours (20 and 12) of prelicensing classroom hours. Original certificates must be signed and submitted with the application.
ADDITIONAL FILING REQUIREMENTS:
The following documents are required to be submitted with the application for the specific license types as listed:
MC- Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring insurance company.
SL- $50,000 bond (Form 447-31 (Rev. 1/2003)) with a properly executed Power of Attorney form attached.
SP- $10,000 bond (Form 447-32 (Rev. 1/2003)) with a properly executed Power of Attorney form attached. CS- $10,000 bond (Form 447-70 (Rev. 12/2003)) with a properly executed Power of Attorney form attached.
CI- Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring insurance company and/or Business Entity Endorsement (Form 411-8A (Rev. 12/2003)) completed by sponsoring Business Entity.
The following documents may be submitted with the initial application. Submitting these documents at a later date will not delay the issuance of your license, however, no authority to transact insurance will be granted until such time as the document has been received. If submitting an online application, these documents are to be submitted after your license is issued:
PF- Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring fraternal benefit society or association admitted to California.
LX- Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring insurance company and/or; Business Entity Endorsement (Form 411-8A completed by sponsoring business entity. To be granted variable authority acceptable proof of registration with SECO or NASD must be submitted with application and you must be appointed by an insurer authorized for variable contracts. Failure to submit proof of registration will result in license being issued without variable authority.
TA-Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring insurance company.
FX/PL- License authority is determined by what documents are submitted. To act as a:
BROKER- $10,000 bond (Form 417-5 (Rev. 10/2002)) with properly executed Power of Attorney form attached and/or Business Entity Endorsement (Form 411-8A (Rev. 12/2003)) completed by sponsoring Business Entity.
AGENT- Action Notice of Appointment (Form 447-54A (Rev. 03/2006)) from the sponsoring insurance company and/or Business Entity Endorsement (Form 411-8A (Rev. 12/2003)) completed by sponsoring Business Entity.
SOLICITOR- Action Notice of Solicitor (Form 417-31 (Rev. 7/95)) completed by the sponsoring insurance agent or broker.
> To obtain insurance licensingFORMSby mail, send request to: Department of Insurance, 320 Capitol Mall, Sacramento, CA 95814, or you may phone Sacramento toll free at (800) 967-9331 or (916) 322-3555, press 3. Forms are also available on our Web site athttp://www.insurance.ca.gov
> To obtain insurance licensing information, you may phone our Sacramento office toll free at (800) 967-9331 or (916) 322-3555. You may also obtain licensing information and a complete list of licensing fees by visiting our Web site at http://www.insurance.ca.gov
>
> MAIL APPLICATION WITH ATTACHMENTS AND FEES TO:
DEPARTMENT OF INSURANCE
P. O. BOX 1139
SACRAMENTO, CA 95812-1139
(b) Form 441-11 for organizations.
NOTICE: INFORMATION COLLECTION AND ACCESS
Section 1798.17 of the California Civil Code requires the following information to be provided when collecting information from individuals to determine compliance with the group and corporate practice provisions of the law, and to establish positive identification, to match the names of the certified list provided by the Department of Child Support Services to applicants and licensees, and of responding to requests for this information made by child support agencies.
AGENCY: Department of Insurance ADDRESS: 320 Capitol Mall, Sacramento, Ca 95814-4309 TELEPHONE NUMBER: (800) 967-9331 or (916) 322-3555
TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE: Chief, Producer Licensing Bureau
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION: California Insurance Code, Chapters 5, 6, 7, 8-Part 2, Division 1
THE CONSEQUENCES, IF ANY, OF NOT PROVIDING ALL OR PART OF THE REQUESTED INFORMATION: It is mandatory that you provide all information requested. Omission of any item of requested information will result in the application being rejected as incomplete.
THE PRINCIPAL PURPOSES (S) FOR WHICH THE INFORMATION IS TO BE USED: The information requested will be used to determine qualifications for licensure or certification, to determine compliance with the group and corporate practice provisions of the law and to establish positive identification.
EACH INDIVIDUAL HAS THE RIGHT TO REVIEW OWN PERSONAL FILES MAINTAINED BY THE AGENCY SUBJECT TO ANY LIMITATIONS UNDER THE INFORMATION PRACTICES ACT OF 1977, CIVIL CODE SECTION 1798.40, AND EXEMPTIONS UNDER THE CALIFORNIA PUBLIC RECORDS ACT, GOVERNMENT CODE SECTION 6254.
INSTRUCTIONS FOR COMPLETING BUSINESS ENTITY APPLICATION
RE: “BUSINESS ENTITY TYPE”:
CORPORATION- if already incorporated, attach a copy of your Certificate of Good Standing. If corporation has been formed as a result of a merger, submit a copy of your approved merger papers.
PARTNERSHIP- attach a copy of the partnership agreement (if any). If no agreement, so state on application.The PARTNERSHIP'S FEDERAL IDENTIFICATION NUMBER IS MANDATORYand must be entered in the space shown.
LIMITED LIABILITY COMPANY- attach a copy of your approved articles of organization. Additional requirements are listed on page 4. This documentation must be submitted with your application.
RE: “BUSINESS ENTITY NAME”: The true business entity name must be entered. Include commas, hyphens, ampersands, etc. This name is subject to disapproval by the Insurance Commissioner.
RE: “FICTITIOUS NAME”: If you intend to transact insurance in a name other than the true business entity name, enter such fictitious name. This name is subject to disapproval by the Insurance Commissioner.
RE: “DESIGNATED/RESPONSIBLE LICENSED PRODUCER”: You must list all licensed producers intending to transact on behalf of the business entity. All unlicensed producers intending to transact on behalf of the business entity must complete form 441-9.
RE: “CONTROLLING PERSON”: Insurance Code Section 1668.5(b), in part, defines a “controlling person” as a person who possesses the power to direct or cause the direction of the management and policies of the business entity.
RE: “BACKGROUND INFORMATION”: If the answer is “yes” to any of these questions, you must submit required documentation.
RE: “APPLICANT'S CERTIFICATION”: Partnership- each partner of the partnership must sign.Corporation or Association- an officer having authority to bind the Corporation or Association must sign.
FEES
A) Licenses are issued for a two-year term, which begins the date the first license is issued to the business entity and ends the last day of that calendar month two years later. Subsequent licenses are issued for the balance of the established license term.
B) Fees: Filing fees are required for each business entity application submitted, except that Surplus Line or Special Lines' fees may vary - see below:
SURPLUS AND SPECIAL LINES' FILING FEES:
1) One filing fee covers the firstTWOnatural persons named under either of these license types. An additional filing fee is required for each subsequent natural person to be named on the license.
2) Fees collected from one person for either the Surplus Line or Special Lines' license cover that person's fees for both licenses.
C) Total fee due is determined by adding the appropriate filing fees in (A) and (B) above to other applicable fees listed in enclosed fee chart.
> PLEASE REVIEW THE APPLICATION CAREFULLY AFTER COMPLETION. ANY OMISSIONS OR DEFICIENCIES WILL RESULT IN A DELAY IN THE PROCESSING OF YOUR APPLICATION FOR LICENSE. > MAIL APPLICATION WITH FEES TO:
DEPARTMENT OF INSURANCE
P. O. BOX 1139
SACRAMENTO, CA 95812-1139
> DIRECT QUESTIONS REGARDING THIS FILING TO THE PRODUCER LICENSING BUREAU IN SACRAMENTO, (800) 967-9331 or (916) 322-3555 > ALL FEES ARE FILING FEES AND ARE NOT REFUNDABLE OR TRANSFERABLE, WHETHER OR NOT THE APPLICATION IS ACTED UPON OR THE EXAMINATION TAKEN.
(c) Form Lic. SSA 1.
The list of authorized endorsees shall be made on Form Lic. SSA 1. The list shall be maintained in a format capable of transmission to the Commissioner or a designee of the Commissioner electronically and in hard copy or diskette, however requested by the Commissioner or a designee of the Commissioner pursuant to Section 2194.15(c) above. The electronic version shall be transmitted in commercial word-processing or spreadsheet form. When requested, the list shall be updated to include endorsees newly authorized up to thirty (30) days before the mailing date of the request, and shall include the dates upon which each endorsee's authorization began and, if relevant, terminated. It shall then be transmitted as an attachment to the e-mail or by regular mail in hard copy or diskette, as requested.
The appropriate e-mail or regular mailing addresses shall be posted by the Department on its website at http://www.insurance.ca.gov.
Authorized Endorsees - Self-Service Storage Facility
Form Lic. SSA 1
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95812-1139
Information: (800) 967-9331 Or (916) 322-3555
www.insurance.ca.gov
California Department of Insurance
Self-Service Storage Agent
Authorized Endorsees
Pursuant to CIC Section 1758.72(d)
Effective Date:__________________________
The listed endorsees, having met the training requirements of California Insurance Code Section 1758.72(a) are authorized to offer the following types of insurance in connection with the rental of self-service storage space.
1. Hazard insurance providing coverage to renters for the loss of, or damage to, tangible personal property in storage or in transit during the rental period, only in connection with and incidental to, self-service storage rental agreements.
Note: This form must be completed annually and maintained for a three year period pursuant to CIC section 1758.72(d)
(d) Form Lic. SSA 2.
The insurer certification shall be made on Form Lic. SSA 2.
(e) Form Lic. SSA 3.
Training materials submitted to the Commissioner shall contain all of the elements set forth in Form Lic. SSA 3.
Required Training Elements - Self-Service Storage Facility
Form Lic. SSA 3
(f) All forms set forth in their entirety in this section are available upon request, by telephone or in writing to the Department of Insurance or on the website of the Department of Insurance at www.insurance.ca.gov.
Note: Authority cited: Sections 1758.7 and 1758.792, Insurance Code. Reference: Sections 1758.7, 1758.71 and 1758.72, Insurance Code.
HISTORY
1. New section filed 6-30-2006 as an emergency; operative 6-30-2006 (Register 2006, No. 26). A Certificate of Compliance must be transmitted to OAL by 10-30-2006 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 6-30-2006 order, including amendments to forms, transmitted to OAL 8-31-2006 and filed 10-16-2006 (Register 2006, No. 42).
This database is current through 6/24/22 Register 2022, No. 25
10 CCR § 2194.16, 10 CA ADC § 2194.16
End of Document