"Application for Managing General Agent License" - Nebraska

Application for Managing General Agent License is a legal document that was released by the Nebraska Department of Insurance - a government authority operating within Nebraska.

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  • Released on July 1, 2020;
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NEBRASKA DEPARTMENT OF INSURANCE
APPLICATION FOR MANAGING GENERAL AGENT LICENSE
This application must be completed in full. You have the duty to provide correct answers to all questions in this application.
This application may be denied if any answer is incorrect or incomplete.
Check One
Resident
__________________________________________________________
Nonresiden
Nonresident
t
Legal Name
__________________________________________________________
_______________________________
Business Address
Federal I.D. Number
______________________________
__________
_________________
_________________________
City
State
Zip Code
Phone
List below the information for all licensed producers which the agency hereby designates shall have full responsibility for the
conduct of all business transactions of the insurance agency within the state relative to insurance. Any individual associated with
a licensed agency who solicits insurance shall be a licensed producer.
NAME OF PRODUCER
LICENSE NUMBER
TITLE OR POSITION
On behalf of the business entity or limited liability company, the undersigned owner, partner, officer or director of the business entity, or member or
manager of a limited liability company, hereby certifies, under penalty of perjury, that:
1. All of the information submitted in this application and attachments is true and complete and I am aware that submitting false information or omitting pertinent or
material information in connection with this application is grounds for license or registration revocation and may subject me and the business entity or limited
liability company to civil or criminal penalties.
2. Unless provided otherwise by law or regulation of the jurisdiction , the business entity or limited liability company hereby designates the Commissioner, Director
or Superintendent of Insurance, or an appropriate representative in each jurisdiction for which this application is made to be its agent for service of process
regarding all insurance matters in the respective jurisdiction and agree that service upon the Commissioner or Director of that jurisdiction is of the same legal
force and validity as personal service upon the business entity.
3. The business entity or limited liability company grants permission to the Commissioner or Director of Insurance in each jurisdiction for which this application is
made to verify any information supplied with any federal, state or local government agency, current or former employer or insurance company.
4. Every owner, partner, officer or director of the business entity, or member or manager of a limited liability company, either a) does not have a current child support
obligation, or b) has a child-support obligation and is currently in compliance with that obligation.
5. I authorize the jurisdictions to give any information they may have concerning me to any federal, state or municipal agency, or any other organization and I release
the jurisdictions and any person acting on their behalf from any and all liability of whatever nature by reason of furnishing such information.
6. I acknowledge that I understand and comply with the insurance laws and regulations of the jurisdictions to which I am applying for licensure/registration.
7. For Non-Resident License Applications, I certify that I am licensed and in good standing in my home state/resident state for the lines of authority requested from the
non-resident state.
8. I hereby certify that upon request, I will furnish the jurisdiction(s) to which I am applying, certified copies of any documents attached to this application or
requested by the jurisdiction(s).
Must be signed by an officer, director, or partner of the business entity, or member or manager if a limited liability company:
_____________________________________________
___________________________________
Signature
Date
_____________________________________________
___________________________________
Typed or Printed Name
Title
A LICENSE FEE OF $50.00 MUST BE SUBMITTED WITH THIS APPLICATION
DOI-MGA
Rev 10/15
NEBRASKA DEPARTMENT OF INSURANCE
APPLICATION FOR MANAGING GENERAL AGENT LICENSE
This application must be completed in full. You have the duty to provide correct answers to all questions in this application.
This application may be denied if any answer is incorrect or incomplete.
Check One
Resident
__________________________________________________________
Nonresiden
Nonresident
t
Legal Name
__________________________________________________________
_______________________________
Business Address
Federal I.D. Number
______________________________
__________
_________________
_________________________
City
State
Zip Code
Phone
List below the information for all licensed producers which the agency hereby designates shall have full responsibility for the
conduct of all business transactions of the insurance agency within the state relative to insurance. Any individual associated with
a licensed agency who solicits insurance shall be a licensed producer.
NAME OF PRODUCER
LICENSE NUMBER
TITLE OR POSITION
On behalf of the business entity or limited liability company, the undersigned owner, partner, officer or director of the business entity, or member or
manager of a limited liability company, hereby certifies, under penalty of perjury, that:
1. All of the information submitted in this application and attachments is true and complete and I am aware that submitting false information or omitting pertinent or
material information in connection with this application is grounds for license or registration revocation and may subject me and the business entity or limited
liability company to civil or criminal penalties.
2. Unless provided otherwise by law or regulation of the jurisdiction , the business entity or limited liability company hereby designates the Commissioner, Director
or Superintendent of Insurance, or an appropriate representative in each jurisdiction for which this application is made to be its agent for service of process
regarding all insurance matters in the respective jurisdiction and agree that service upon the Commissioner or Director of that jurisdiction is of the same legal
force and validity as personal service upon the business entity.
3. The business entity or limited liability company grants permission to the Commissioner or Director of Insurance in each jurisdiction for which this application is
made to verify any information supplied with any federal, state or local government agency, current or former employer or insurance company.
4. Every owner, partner, officer or director of the business entity, or member or manager of a limited liability company, either a) does not have a current child support
obligation, or b) has a child-support obligation and is currently in compliance with that obligation.
5. I authorize the jurisdictions to give any information they may have concerning me to any federal, state or municipal agency, or any other organization and I release
the jurisdictions and any person acting on their behalf from any and all liability of whatever nature by reason of furnishing such information.
6. I acknowledge that I understand and comply with the insurance laws and regulations of the jurisdictions to which I am applying for licensure/registration.
7. For Non-Resident License Applications, I certify that I am licensed and in good standing in my home state/resident state for the lines of authority requested from the
non-resident state.
8. I hereby certify that upon request, I will furnish the jurisdiction(s) to which I am applying, certified copies of any documents attached to this application or
requested by the jurisdiction(s).
Must be signed by an officer, director, or partner of the business entity, or member or manager if a limited liability company:
_____________________________________________
___________________________________
Signature
Date
_____________________________________________
___________________________________
Typed or Printed Name
Title
A LICENSE FEE OF $50.00 MUST BE SUBMITTED WITH THIS APPLICATION
DOI-MGA
Rev 10/15
NEBRASKA DEPARTMENT OF INSURANCE
BOND FOR MANAGING GENERAL AGENTS
KNOW ALL BY THESE PRESENTS THAT we ______________________________, as
Principal and, ______________________________ as Surety, are held and firmly bound unto
the State of Nebraska as Obligee, for the benefit and protection of insureds and of insurers
domiciled in the State of Nebraska whose monies the Managing General Agent handles, in the
amount of, ___________________________________ ($____________) lawful money of the
United States, for the payment of which we hereby bind ourselves and our heirs, administrators,
successors, and assigns, jointly and severally.
WHEREAS, the Director of Insurance for the State of Nebraska shall license Managing General
Agents in accordance with the Managing General Agents Act, Neb.Rev.Stat. §44-4903 et seq.
and Rule 59 of Title 210 of the Nebraska Administrative Code which requires Managing General
Agents contracting to perform services for an insurer domiciled in the State of Nebraska, to post
a bond to secure performance in conformity with the Managing General Agents Act and Rule 59.
WHEREAS, the above-named Principal has made application for such license and, pursuant to
section 004 of Rule 59, is required to post a bond to secure the performance of the Managing
General Agent in conformity with the Managing General Agents Act and Rule 59.
WHEREAS, the above-named Surety is authorized to transact surety business in the State of
Nebraska.
NOW THEREFORE, if the Director of Insurance shall grant a license referred herein, and all
agents and employees representing the Principal shall faithfully and lawfully conform to and
abide by the provisions of the Managing General Agents Act and any rules promulgated
thereunder, then this obligation shall be null and void; otherwise, it shall remain in full force and
effect.
IT IS AGREED THAT THE FOLLOWING CONDITIONS APPLY:
1. That any person who sustains an injury covered by this bond may bring an action in his
own name upon this bond for recovery of any damages sustained by such person;
2. That the total aggregate liability of the surety on this bond shall be limited to the payment
of ________________________________________ dollars ($____________)
3 It is understood and agreed that this bond take effect on the __________ day of
____________________, 20______ and shall be continuous in nature and shall remain in
force until canceled by the underwriter or released by the Director; and
4. It is further understood and agreed that if the surety so elects, this bond may be canceled
only upon giving sixty (60) day notice in writing to the Director and Principal.
Cancellation by the surety shall not affect any liability or obligation incurred or accrued
prior to the effective date of the cancellation.
Rev 7/2020
DOI-MGABOND
Page 1 of 2
IN WITNESS WHEREOF, the Principal and Surety have caused this bond to be executed and set
their hands and seals this
day of ____________________, 20______.
_____________________________________
Witnesses:
Principal Name
_____________________________________
____________________________________
Principle Signature
(as to Principal)
_____________________________________
____________________________________
Surety Name
(as to Surety)
____________________________________
Attorney-in-Fact Signature
NEBRASKA DEPARTMENT OF INSURANCE
INSURANCE LICENSING DIVISION
P.O. BOX 82089
LINCOLN, NE 68501-2089
E-mail: DOI.Licensing@Nebraska.gov
Licensing Division: (402) 471-4913
DOI Main Line: (402) 471-2201
Fax: (402) 471-4610
Rev 7/2020
DOI-MGABOND
Page 1 of 2
REQUIREMENTS FOR TRANSACTING BUSINESS
AS A MANAGING GENERAL AGENT
Article 49
Section 44-4901 Act, how cited.
Sections 44-4901 to 44-4910 shall be known and may be cited as the Managing General Agents Act.
Section 44-4902 Terms, defined.
For purposes of the Managing General Agents Act:
(1) Actuary means a person who is a member in good standing of the American Academy of Actuaries;
(2) Business entity means a corporation, association, partnership, limited liability company, limited liability
partnership, or other legal entity;
(3) Director means the Director of Insurance;
(4) Insurer means any person duly licensed in this state as an insurance company pursuant to Chapter 44;
(5) Managing general agent means any person who manages all or part of the insurance business of an
insurer, including the management of a separate division, department, or underwriting office, and acts as
an agent for such insurer, whether known as a managing general agent, manager, or other similar term,
who, with or without the authority, either separately or together with affiliates, produces, directly or
indirectly, and underwrites in any one quarter or year an amount of gross direct written premium equal to
or more than five percent of the policyholders surplus as reported in the last annual statement of the
insurer in any one quarter or year and who (a) adjusts or pays claims in excess of ten thousand dollars or
(b) negotiates reinsurance on behalf of the insurer. Managing general agent does not include an attorney
in fact for a reciprocal or interinsurance exchange under a power of attorney, an employee of the insurer,
a United States manager of the United States branch of an alien insurer, or an underwriting manager who,
pursuant to contract, manages all or part of the insurance operations of the insurer, is under common
control with the insurer, and is subject to the Insurance Holding Company System Act and whose
compensation is not based on the volume of premiums written;
(6) Person means an individual or a business entity; and
(7) Underwrite means the authority to accept or reject risk on behalf of the insurer.
Section 44-4903 License; requirements.
No person shall act in the capacity of a managing general agent with respect to risks located in this state for an
insurer licensed in this state unless such person is licensed in accordance with the Insurance Producers
Licensing Act. No person shall act in the capacity of a managing general agent representing an insurer
domiciled in this state with respect to risks located outside this state unless such person is licensed in
accordance with such act.
Section 44-4904 Contract; requirements.
No person acting in the capacity of a managing general agent shall place business with an insurer unless there is
in force a written contract between the parties which sets forth the responsibilities of each party and, if both
parties share responsibility for a particular function, specifies the division of such responsibilities and which
contains the following minimum provisions:
(1) The insurer may terminate the contract for cause upon written notice to the managing general agent. The
insurer may suspend the underwriting authority of the managing general agent during the pendency of
any dispute regarding the cause for termination;
(2) The managing general agent will render accounts to the insurer detailing all transactions and remit all
funds due under the contract to the insurer on not less than a monthly basis;
(3) All funds collected for the account of an insurer will be held by the managing general agent in a fiduciary
capacity in an institution that is insured by the Federal Deposit Insurance Corporation. The account shall
be used for all payments on behalf of the insurer. The managing general agent may retain no more than
three months’ estimated claims payments and allocated loss adjustment expenses;
(4) Separate records of business written by the managing general agent will be maintained. The insurer shall
have access and right to copy all accounts and records related to its business in a form usable by the
insurer, and the director shall have access to all books, bank accounts, and records of the managing
general agent in a form usable to the director. Such records shall be retained as determined by the
director;
(5) The contract may not be assigned in whole or in part by the managing general agent;
(6) Appropriate underwriting guidelines, including:
(a) The maximum annual premium volume;
(b) The basis of the rates to be charged;
(c) The types of risks which may be written;
(d) Maximum limits of liability;
(e) Applicable exclusions;
(f) Territorial limitations;
(g) Policy cancellation provisions; and
(h) The maximum policy period. The insurer shall have the right to cancel or nonrenew any
policy of insurance subject to applicable insurance statutes and regulations;
(7) The insurer shall require the managing general agent to obtain and maintain a surety bond for the
protection of the insurer. The bond amount shall be at least one hundred thousand dollars or ten percent
of the managing general agent’s total annual written premium nationwide produced by the managing
general agent for the insurer in the prior calendar year, whichever is greater, but not greater than five
hundred thousand dollars;
(8) The insurer may require the managing general agent to maintain an errors and omissions policy;
(9) If the contract permits the managing general agent to settle claims on behalf of the insurer:
(a) All claims must be reported to the insurer in a timely manner;
(b) A copy of the claim file will be sent to the insurer at its request or as soon as it becomes known that
the claim:
(i) Has the potential to exceed an amount determined by the director or exceeds the limit set by the
insurer, whichever is less;
(ii) Involves a coverage dispute;
(iii) May exceed the managing general agent’s claims settlement authority;
(iv) Is open for more than six months; or
(v) Is closed by payment of an amount set by the director or an amount set by the insurer,
whichever is less;
(c) All claim files will be the joint property of the insurer and the managing general agent. Upon an order
of liquidation of the insurer, such files shall become the sole property of the insurer or its estate, and
the managing general agent shall have reasonable access to and the right to copy the files on a timely
basis; and
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