Not Assigned Annual Checklist for Certified Companies

ANNUAL FILING CHECKLIST
CERTIFIED COMPANIES
THE FOLLOWING CHECKLIST IS PROVIDED TO AID YOUR COMPANY IN
ELECTRONICALLY SUBMITTING A COMPLETE FILING TO THIS DEPARTMENT
(COPY OF THIS CHECKLIST IS TO BE SUBMITTED WITH FILING)

REPORTING COMPANY NAME:

CONTACT PERSON NAME AND TITLE:

CONTACT PERSON PHONE NO. AND E-MAIL ADDRESS:

ITEMS TO BE SUBMITTED

1. Copy Renewal Fee Receipt (pay on-line at
http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm)
2. Signed and Notarized Jurat Page for Annual Financial Statement of Reporting
3. NAIC UPLOAD FILE (s.txt file only)
4. For Subsidiaries Shown on Schedule D:
a. NAIC UPLOAD FILE (s.txt file only)
5. Surety License Form (form provided on-line) – Provide all current information
6. Treasury Schedule F (form provided on-line)*
7. Copies of LOC’s and Trust Agreements for Largest Recoverable Amounts
Reported on Sch. F, Part 2, Columns 4a and 4b
8a. Schedule of Excess Risks (form provided on-line)*
b. Reinsurance Agreement Forms for All Bonds Written with U.S. Government as
the Obligee (SF 273, 274, 275) (Available on-line)*
c. Powers of Attorney for all Attorneys-In-Fact on Reins. Agreement Forms
9. NAIC IRIS Ratios and explanation(s) of IRIS Ratios with Unusual Results

SUBMITTED
YES
NO

10. Current State Exam Report (if not previously provided) and copy of
correspondence responding to Examiner’s recommendations
11. Updated Biographical Affidavits of New Officers and Directors (use NAIC
Format)
12. Bail Bond Reserve Schedule (if applicable)
13. Description of Miscellaneous Assets Reported on Page 1 of the Annual
Financial Statement
14. Current Appraisals for Mortgage Loans and Real Estate Acquired During this
Past Year
15. Insurance Dept. Certificates:
- verifying large infusions of capital or surplus
- verifying approval of extraordinary dividend
16. Documents Describing Changes in the Company (i.e., name change, ownership
change, change in state of incorporation, change in CPA audit firms, etc.)
17. Copies of Change to Charter or Articles of Incorporation or Bylaws which
Occurred this Past Year
18. Report on Federal Business Written, Assumed and/or Outstanding (form
provided on-line)*

*ALL OF OUR FORMS ARE AVAILABLE ON-LINE AT

http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm
**NOTE: IT IS NOT NECESSARY TO SUBMIT INSURANCE EXPENSE EXHIBITS**

*** THE SURETY BOND PROGRAM ONLY ACCEPTS ELECTRONIC SUBMISSIONS
OF DOCUMENTS (FACSIMILE SIGNATURES ARE ACCEPTABLE) ***
Annual Filing Checklist Certified
Companies Rev. 8/2017
OMB No. 1530-0061