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A renewal packet is to be completed by an insurer's representative for each MGA it utilizes each year. The renewal packet and fee must be received thirty (30) days prior to the MGA's expiration date.
The application must be tabbed to correspond with its number in the below requirements.
Tab 1. A completed MGA renewal application and application fee of $100
Tab 2. Certified copy of the Fidelity Bond (pursuant to IC 27-1-33-6) (Certificate of Insurance is not acceptable)
Tab 3. Copy of the Errors and Omissions policy (pursuant to IC 27-1-33-6)
Tab 4. Annual financial compilation prepared by an independent certified acountant (pursuant to 760 IAC 1-52-6)
Tab 5. A listing of current officers and directors.
Tab 6. A signed statement stating that all contract(s) previously filed is(are) still in effect. (If there have been contract changes or a new contract has been issued, see the directions below)
Tab 7. Certification of Gross Direct Written Premium.
Tab 8. Proof of licensure as an Indiana producer. (pursuant to IC 27-1-33-6)
Only required if changes have been made within the last year.
Tab 9. Biographical affidavits for any new officer, director, or partner originally signed and notarized.
Tab 6(a) Copy of any new or amended contract between the MGA and the insurer. The contract must be highlighted indicating the location of the Indiana code citations that correspond with the completed Contract Compliance Checklist showing the section and page number of the citations. (pursuant to IC 27-1-33-7)
*Note - All materials must be received postal mail, no faxes or emailed items accepted*
Submit all items to:
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787