Attachment N, Surplus Placement Acknowledgement.pdf
PDF 120 KB Posted
- Attached to
- Government Crime Insurance
- Solicitation number
- ITB-17050
- Issued by
- Florida
About this file
This is a Surplus Line Placement Acknowledgement form (Attachment N) required for the Government Crime Insurance solicitation issued by the Florida Department of Management Services. The form must be completed, signed, and returned by all brokers submitting bids for the Government Crime Insurance contract, regardless of whether the broker proposes coverage placement with a surplus lines insurer. The Department is issuing an Invitation to Bid (ITB) to establish a contract for Government Crime Insurance to replace the current policy, with the intention to make a single award to the lowest responsive and responsible bidder in accordance with Florida Statutes sections 287.057(1) and 287.022. The procurement is being conducted through the MyFloridaMarketPlace Sourcing Event via the SAP Business Network, with all solicitation documents and addenda posted on the Vendor Information Portal (VIP). Interested vendors should direct inquiries to Jill Soderberg, Division of State Purchasing, at jill.soderberg@dms.fl.gov or 850-488-7996.
The Surplus Line Placement Acknowledgement requires brokers to disclose whether they approached both authorized and surplus insurers for coverage and whether the proposed bid placement utilizes a surplus lines insurer. If coverage is proposed through a surplus lines insurer, the broker must certify that premium rates comply with Florida Statute section 629.916(1)(a) and (b), which mandates that rates not be lower than those charged by a majority of authorized insurers for similar coverage on comparable risks and that policy forms not be more favorable than those in current use by authorized insurers. The form requires certification by senior management with signature, printed name, title, and date. The Department reserves the right to make no award if deemed in the best interest of the State, and vendors must monitor the VIP throughout the procurement process and comply with protest procedures outlined in Florida Statute section 120.57(3).
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Text version
SPIP 09/2026
Attachment N Surplus Line Placement Acknowledgement
Brokers shall complete, sign and return this Attachment N regardless of whether the
Broker’s proposed placement of coverage is with a surplus lines user.
1. Did the Broker approach both authorized and surplus insurers for this coverage?
Yes No
2. Is this coverage proposed in the Bid placed via a surplus lines insurer?
Yes No
3. If the Broker’s proposed placement of this coverage is with a surplus lines insurer, the Broker certifies that the premium rates provided in Attachment C, Price Sheet are in accordance with the requirements of section 629.916(1)(a) and (b), F.S. below:
Pursuant to section 626.916(1)(a) and (b), F.S.,
(a) The premium rate at which the coverage is exported shall not be lower than that rate applicable, if any, in actual and current use by a majority of the authorized insurers for the same coverage on a similar risk.
(b) The policy or contract form under which the insurance is exported shall not be more favorable to the insured as to the coverage or rate than under similar contracts on file and in actual current use in this state by the majority of authorized insurers actually writing similar coverages on similar risks; except that a coverage may be exported under a unique form of policy designed for use with respect to a particular subject of insurance if a copy of such form is filed with the office by the surplus lines agent desiring to use the same and is subject to the disapproval of the office within 10 days of filing such form exclusive of Saturdays, Sundays, and legal holidays if it finds that the use of such special form is not reasonably necessary for the principal purposes of the coverage or that its use would be contrary to the purposes of this Surplus Lines Law with respect to the reasonable protection of authorized insurers from unwarranted competition by unauthorized insurers.
By signing below, the Broker certifies that the information provided above is true and accurate.
Entity Name:
Senior Management’s Printed Name:
Senior Management’s Title:
Signature: Date:
File details come from the government source that posted it. Updated .