Form CDI-052 "Appointment of Attorney to Accept Service and Designation for Risk Retention Group" - California

What Is Form CDI-052?

This is a legal form that was released by the California Department of Insurance - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2015;
  • The latest edition provided by the California Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CDI-052 by clicking the link below or browse more documents and templates provided by the California Department of Insurance.

ADVERTISEMENT
ADVERTISEMENT

Download Form CDI-052 "Appointment of Attorney to Accept Service and Designation for Risk Retention Group" - California

548 times
Rate (4.4 / 5) 38 votes
STATE OF CALIFORNIA – DEPARTMENT OF INSURANCE
APPOINTMENT OF ATTORNEY TO ACCEPT SERVICE AND DESIGNATION
FOR RISK RETENTION GROUP
CDI-052 (Rev. 11/2015)
The _____________________________________________________ ("the Group"), a risk retention group
organized under the laws of the State of _______________ having notified the Insurance Commissioner of
the State of California of its intention to do business in this State as a risk retention group pursuant to the
Federal Liability Risk Retention Act of 1986, hereby appoints the Insurance Commissioner of the State of
California, any successor in office, and any authorized deputy its true and lawful attorney, in and for the
State of California, upon whom all legal documents or process in any proceeding against it may be served.
Such service of process shall be of the same legal force and validity as if served personally upon the Group.
The Group designates:
__________________________________________________
(Name)
__________________________________________________
(Address)
__________________________________________________
(City, Town or Village)
__________________________________________________
(State and ZIP Code)
as its officer, agent or other person to whom shall be forwarded all legal documents or process served upon
the Insurance Commissioner of the State of California, any successors in office, or any authorized deputy,
for the Group. This designation shall continue in full force and effect until superseded by a new written
designation filed with the Insurance Commissioner.
CERTIFIED COPY OF RESOLUTION
This appointment and designation is made pursuant to a resolution by the Group's governing body
authorizing it, and a certified copy of the resolution is attached hereto. This appointment shall be binding
upon any person or corporation which as successor acquires the Group's assets or assumes its liabilities, by
merger or consolidation or otherwise. This appointment may be withdrawn only upon a written notice of
termination and, in any event, shall not be terminated by the Group or its successor so long as any contracts
or liabilities or duties arising out of contracts entered into by the Group while it was doing business in this
State are in effect.
IN WITNESS OF THIS APPOINTMENT AND DESIGNATION, the Group, in accordance with the
resolution of its Board of Directors duly passed on _______________________, 20_____, has affixed its
corporate seal, and caused the same to be subscribed and attested in its name by its President and Secretary,
at the City of _______________ in the State of _______________ on _______________________, 20____.
_____________________________________
(Name of Risk Retention Group)
By:
_________________________
By:
_________________________
President
Secretary
_________________________
_________________________
Print or type full name
Print or type full name
STATE OF CALIFORNIA – DEPARTMENT OF INSURANCE
APPOINTMENT OF ATTORNEY TO ACCEPT SERVICE AND DESIGNATION
FOR RISK RETENTION GROUP
CDI-052 (Rev. 11/2015)
The _____________________________________________________ ("the Group"), a risk retention group
organized under the laws of the State of _______________ having notified the Insurance Commissioner of
the State of California of its intention to do business in this State as a risk retention group pursuant to the
Federal Liability Risk Retention Act of 1986, hereby appoints the Insurance Commissioner of the State of
California, any successor in office, and any authorized deputy its true and lawful attorney, in and for the
State of California, upon whom all legal documents or process in any proceeding against it may be served.
Such service of process shall be of the same legal force and validity as if served personally upon the Group.
The Group designates:
__________________________________________________
(Name)
__________________________________________________
(Address)
__________________________________________________
(City, Town or Village)
__________________________________________________
(State and ZIP Code)
as its officer, agent or other person to whom shall be forwarded all legal documents or process served upon
the Insurance Commissioner of the State of California, any successors in office, or any authorized deputy,
for the Group. This designation shall continue in full force and effect until superseded by a new written
designation filed with the Insurance Commissioner.
CERTIFIED COPY OF RESOLUTION
This appointment and designation is made pursuant to a resolution by the Group's governing body
authorizing it, and a certified copy of the resolution is attached hereto. This appointment shall be binding
upon any person or corporation which as successor acquires the Group's assets or assumes its liabilities, by
merger or consolidation or otherwise. This appointment may be withdrawn only upon a written notice of
termination and, in any event, shall not be terminated by the Group or its successor so long as any contracts
or liabilities or duties arising out of contracts entered into by the Group while it was doing business in this
State are in effect.
IN WITNESS OF THIS APPOINTMENT AND DESIGNATION, the Group, in accordance with the
resolution of its Board of Directors duly passed on _______________________, 20_____, has affixed its
corporate seal, and caused the same to be subscribed and attested in its name by its President and Secretary,
at the City of _______________ in the State of _______________ on _______________________, 20____.
_____________________________________
(Name of Risk Retention Group)
By:
_________________________
By:
_________________________
President
Secretary
_________________________
_________________________
Print or type full name
Print or type full name
STATE OF CALIFORNIA – DEPARTMENT OF INSURANCE
APPOINTMENT OF ATTORNEY TO ACCEPT SERVICE AND DESIGNATION
FOR RISK RETENTION GROUP
CDI-052 (Rev. 11/2015)
A notary public or other officer completing this certificate verifies only the identity of the individual
who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or
validity of that document.
State of ______________________)
County of ____________________)
On _____________________________ before me, ___________________________________________
(Notary Public)
personally appeared ____________________________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature ________________________________ (Seal)
Page of 2