Fillable Service Company Permit Application Checklist (Arizona)

Fill Online, Printable, Fillable, Blank Service Company Permit Application Checklist (Arizona) Form

Use Fill to complete blank online ARIZONA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Service Company Permit Application Checklist (Arizona)

On average this form takes 19 minutes to complete

The Service Company Permit Application Checklist (Arizona) form is 2 pages long and contains:

  • 0 signatures
  • 6 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

BROWSE ARIZONA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Service Company Permit Application Checklist
Form E-820 (v. 20180810) Page 1 of 2
Type of Application
New Renewal
Name of Service Company
AZ #
DBA Name of Service Company, if applicable
Name of analyst
Date application received
Date review completed
Application Decision
Decided by:
Decision date:
Communication date:
Requirement
Statute
N/A
Meets
Fails
1
$300 fee
R20-6-
407(C)(2)(d) &
(G)(1)
2
Application Form E-800 & E-811
R20-6-407(C) &
(G)(1)
a.
SECTION A: Applicant holds an ACC Certificate of
Good Standing and the name exactly matches ACC
record (http://ecorp.azcc.gov/Search)
R20-6-407(C) &
(G)(1)
b.
ALL: Every question on the application is answered
R20-6-407(C) &
(G)(1)
c.
SECTION F: The affidavit/attestation is complete and
is signed by officer(s) of the applicant.
R20-6-
407(C)(1)(g)
d.
SECTION D, Item 2: If YES, explanation and
documentation enclosed
e.
SECTION E, Item 4: Number of biographical
affidavits provided match the reported count
R20-6-
407(C)(2)(e)
f.
Each biographical affidavit is fully completed, and
information is consistent with NAIC RIRS/SAD and
other information sources.
g.
For each biographical affidavit with a YES answer to
a background question (NAIC Form 11, Item 11),
application includes a copy of the complaint and the
filed adjudication/settlement for each matter.
Reset
Service Company Permit Application Checklist
Form E-820 (v. 20180810) Page 2 of 2
Requirement
Statute
N/A
Meets
Fails
3
Financial statements as of the most recent fiscal
year end
R20-6-407(C)(2) &
(G)(1)
a.
Financial statements have been certified by officer(s) of the applicant
b.
Net Income – Current Income Statement = SECTION C, Item 1
$
c.
Applicant provided non-consolidated GAAP balance sheets for the two
preceding years
d.
Current Assets – Current Balance Sheet = SECTION C, Item 2
$
e.
Current Liabilities – Current Balance Sheet = SECTION C, Item 3
$
f.
Working Capital – Current Balance Sheet = SECTION C, Item 4
$
g.
Owner’s Equity – Current Balance Sheet = SECTION C, Item 5
$
h.
If the net income, working capital or owner/stockholder equity is
negative, applicant included mitigation explanation
4
Trust deposit by Surety bond
Marketable securities
MR/CL Insurance policy
a.
$100,000 = SECTION E, Item 2
20-1095.04
$100,000
b.
Amount of trust deposit (must be at least Line 4a)
$
c.
For a surety bond (may include individual bonds
or schedule or blanket forms of bonds):
NAIC# ________ of AZ-authorized insurer
Yes No Form E-857
Yes No Attorney-in-Fact
d.
For a marketable security:
Yes
Yes
e.
For a mechanical reimbursement (contractual
liability) insurance policy:
Yes
Yes
No Copy of policy
No In force confirmation
No Custody Agreement
No Form E125
0
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Service Company Permit Application Checklist (Arizona)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 July 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document