Fillable ANNUAL FILING CHECKLIST CERTIFIED COMPANIES (Department of the Treasury - OCIO)

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ANNUAL FILING CHECKLIST CERTIFIED COMPANIES (Department of the Treasury - OCIO)

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BROWSE DEPARTMENT OF THE TREASURY - OCIO (DC) FORMS

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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:
SUBMITTED
ITEMS TO BE SUBMITTED
YES NO
1. Copy of 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
10. Current State Exam Report (if not previously provided) and copy of
correspondence resp
onding 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 Yea
r
18. Report on Federal Business Written, Assumed and/or Outstanding (form
provided on-line)*
*ALL OF OUR F
ORMS ARE AVAILABLE ON-LINE AT
http://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm
**NO
TE: IT IS NOT NECESSARY TO SUBMIT INSURANCE EXPENSE EXHIBITS**
*** THE SURETY BOND PROGRAM ONLY ACCEPTS ELECTRONIC
SUBMISSIONS OF DOCUMENTS ***
Annual Filing Checklist Certified
Companies
Rev. 12/2019
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ANNUAL FILING CHECKLIST CERTIFIED COMPANIES (Department of the Treasury - OCIO)

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Completed 10 August 2020

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