"Risk Retention Group - Notice and Registration" - Mississippi

Risk Retention Group - Notice and Registration is a legal document that was released by the Mississippi Department of Insurance - a government authority operating within Mississippi.

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Part A
MISSISSIPPPI INSURANCE
DEPARTMENT
RISK RETENTION GROUP - NOTICE AND REGISTRATION
(All Information Should Be Typed)
1a.
Name of the Risk Retention Group as it appears on its Certificate of Authority:
1b.
Address of the Risk Retention Group:
1c.
NAIC Company Code:
1d.
FEIN:
1e.
State of domicile, date licensed and date chartered:
1f.
Primary contact person for state of domicile to whom questions regarding the Risk Retention
Group should be addressed (include name, phone number and email address):
2.
List any other name(s) by which the Risk Retention Group is known or may be doing business in
this State or any other state:
3.
The Risk Retention Group is authorized to engage in the following lines and/or classifications
of liability insurance under the laws of its chartering State:
4.
Give a general description of the liability insurance coverages the Risk Retention Group plans to
write in the state it is registering to do business in.
Mississippi Risk Retention Group Registration
1
Part A
MISSISSIPPPI INSURANCE
DEPARTMENT
RISK RETENTION GROUP - NOTICE AND REGISTRATION
(All Information Should Be Typed)
1a.
Name of the Risk Retention Group as it appears on its Certificate of Authority:
1b.
Address of the Risk Retention Group:
1c.
NAIC Company Code:
1d.
FEIN:
1e.
State of domicile, date licensed and date chartered:
1f.
Primary contact person for state of domicile to whom questions regarding the Risk Retention
Group should be addressed (include name, phone number and email address):
2.
List any other name(s) by which the Risk Retention Group is known or may be doing business in
this State or any other state:
3.
The Risk Retention Group is authorized to engage in the following lines and/or classifications
of liability insurance under the laws of its chartering State:
4.
Give a general description of the liability insurance coverages the Risk Retention Group plans to
write in the state it is registering to do business in.
Mississippi Risk Retention Group Registration
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5.
Has the Risk Retention Group’s domiciliary state approved the Risk Retention Group to register
and expand its writings in the state it is seeking to become registered in?
6.
Ownership of the Risk Retention Group consists of one or the other of the following (check one):
a)
the owners of the Group are only persons who comprise the membership of the
Group and who are provided insurance by the Group.
b)
the sole owner of the Group is:
(Name and Address of Organization)
an organization which has as its members only persons who comprise the membership of
the Group and which has as its owners only persons who comprise the membership of the
Group and who are provided insurance by the Group.
7.
The Risk Retention Group members are engaged in businesses or activities similar or related with
respect to the liability to which such members are exposed by virtue of any related, similar or
common business (whether profit or nonprofit), trade, product, services (including professional
services), premises or operations. Give a general description of businesses or activities engaged in
by the Group’s members:
8.
(a) List the name, position with the Risk Retention Group, and address of each officer and
director of the Risk Retention Group: (Attach additional pages, if necessary.)
(b) Identify and give the telephone number of the officer or director of the Risk Retention Group
who can be contacted for any information regarding the management of the insurance activities of
the Group:
Name:
Telephone #:
Mississippi Risk Retention Group Registration
2
9.
List the name, address, and telephone number of the company responsible for managing the
insurance operations of the Risk Retention Group and the company contact person’s name,
telephone number and email. (If none, answer none.)
Contact Person:
Telephone #
Email:
10.
List the name(s) NPR#, and address(es) of the licensed insurance agent(s) or broker(s) who will
be responsible for marketing the Risk Retention Group’s insurance policies in the State of [Insert
State in which the Risk Retention Group intends to do business] and the current licensing status in
the State of [Insert State in which the Risk Retention Group intends to do business]: (If none,
answer none. Attach additional pages, if necessary.)
Name
NPR#
Address
License Status in State
Registering
11.
In accordance with the Liability Risk Retention Act, we verify the following:
A.
The Risk Retention Group is a corporation or other limited liability association whose
primary activity consists of assuming and spreading all, or any portion, of the liability
exposure of its members.
B.
The Risk Retention Group is organized for the primary purpose of conducting the activity
described under Item “A” above.
C.
The Risk Retention Group does not exclude any person from membership in the Group
solely to provide for members of the Group a competitive advantage over such a person.
D.
The activities of the Risk Retention Group do not include the provision of insurance other
than:
i.
liability insurance for assuming and spreading all or any portion of the similar or
related liability exposure of its Group members; and
ii.
reinsurance with respect to the similar or related liability exposure of another Risk
Retention Group (or a member of such other Risk Retention Group) engaged in
business or activities so that such Risk Retention Group or member meets the
requirement under Item #7 above for membership in the Risk Retention Group which
provides such reinsurance.
Mississippi Risk Retention Group Registration
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12.
In accordance with the LRRA, if the State in which the Risk Retention Group is registering requires
compliance with the following laws and requirements, the RRG agrees to the following:
A.
The Risk Retention Group will comply with the unfair claim settlement practices laws of
this State.
B.
The Risk Retention Group will pay, on a non-discriminatory basis, applicable premium and
other taxes which are levied on admitted insurers, surplus line insurers, brokers or
policyholders under the laws of this State.
T
C.
he Risk Retention Group will participate, on a nondiscriminatory basis, in any mechanism
established or authorized under the law of the State for the equitable apportionment among
insurers of liability insurance losses and expenses incurred on policies written through such
mechanism.
D.
The Risk Retention Group will designate the Insurance Commissioner [Director,
Superintendent] of this State as its agent solely for the purpose of receiving service of legal
documents or process by executing Part B of this form, attached hereto.
E.
The Risk Retention Group will submit to examination by the Insurance Commissioner
[Director, Superintendent] of this State to determine the Group’s financial condition, if:
the Insurance Commissioner [Director, Superintendent] of the Group’s chartering
i.
State has not begun or has refused to initiate an examination of the Group; and
ii.
any such examination by the Insurance Commissioner [Director, Superintendent]
shall be coordinated to avoid unjustified duplication and unjustified repetition.
F.
The Risk Retention Group will comply with a lawful order issued in a delinquency
proceeding commenced by the Insurance Commissioner [Director, Superintendent] of this
State upon a finding of financial impairment, or in a voluntary dissolution proceeding.
G.
The Risk Retention Group will comply with the laws of this State regarding deceptive, false
or fraudulent acts or practices, including any injunctions regarding such conduct obtained
from a court of competent jurisdiction.
H.
The Risk Retention Group will comply with an injunction issued by a court of competent
jurisdiction upon petition by the Insurance Commissioner [Director, Superintendent] of this
State alleging that the Group is in hazardous financial condition or is financially impaired.
I.
The Risk Retention Group will provide the following notice, in at least 10-point type, in any
insurance policy issued by the Group:
NOTICE
This policy is issued by your risk retention group. Your risk retention group may
not be subject to all of the insurance laws and regulations of your State. State
insurance insolvency guaranty funds are not available for your risk retention group.
13.
In accordance with the LRRA, the Risk Retention Group affirms that it has submitted to the
Insurance Commissioner [Director, Superintendent] as part of this filing and before it has offered
any insurance in this State, a copy of the plan of operation or feasibility study which it has filed with
Mississippi Risk Retention Group Registration
4
the Insurance Commissioner [Director, Superintendent] of its state of domicile. This plan or study
includes the name of the State in which the Group is chartered, as well as the Group’s principal
place of business, and such plan of operation or feasibility study further includes the coverages,
deductibles, coverage limits, rates, and rating classification systems for each line of liability
insurance the Group intends to offer. The Group has also submitted to the Insurance Commissioner
[Director, Superintendent] of this State any revisions of such plan of operation or feasibility study to
reflect any changes if the Group intends to offer any additional lines of liability insurance or change
in the designation of the State in which it is chartered.
14.
The Risk Retention Group will submit a copy of its annual financial statement submitted to its
chartering state, to the Insurance Commissioner [Director, Superintendent] of this State. The annual
financial statement shall be certified by an independent public accountant and include a statement of
opinion on loss and loss adjustment expense reserves made by a member of the American Academy
of Actuaries or a qualified loss reserve specialist. The annual financial statement, certification and
statement of opinion on loss and loss adjustment expense reserves will be submitted to the Insurance
Commissioner [Director, Superintendent] of this State by the date it is required to be submitted to its
chartering state.
15.
The Risk Retention Group will not solicit or sell insurance to any person in this State who is not
eligible for membership in the Group.
16.
The Risk Retention Group will not solicit or sell insurance in this State, or otherwise operate in this
State, if the Group is in hazardous financial condition or is financially impaired.
In accordance with the LRRA, the terms of any insurance policy provided by the Risk
17.
Retention Group shall not provide or be construed to provide insurance policy coverage
prohibited generally by State statute or declared unlawful by the highest court of the State
whose law applies to such policy.
18.
To the extent required by the LRRA, the Risk Retention Group will comply with all other applicable
state laws.
19.
The Risk Retention Group will notify the Insurance Commissioner [Director, Superintendent] as to
any subsequent changes in any of the items included in this form (except for items #1f, #8 and #10).
The undersigned hereby swear and affirm that the foregoing statements and information regarding their
principal, the
(Name of Risk Retention Group) are true and correct.
President of the Risk Retention Group
Secretary of the Risk Retention Group
State of
)
ss:
County of
)
Sworn before me this
day of
, 20
.
, Notary Public. My Commission Expires:
Mississippi Risk Retention Group Registration
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