STATE OF CALIFORNIA ­ DEPARTMENT OF INSURANCE APPLICATION FOR A REISSUED LICENSE TO ACT AS AN UNDERWRITTEN TITLE COMPANY CDI-059 (Rev. 7/2016) This application is to be used in connection with adding and deleting counties to an underwritten title company license. Instructions: Please answer each question as thoroughly as possible. As you complete this application, place a check in the box next to the item number to indicate that the requested information has been attached or is otherwise included in the application. · · · If items are attached to this application, please number the attachment corresponding to the number of the item below and provide a separate list of attachments. If the question is not applicable, please state "not applicable" in the space provided. If information or supporting documentation is requested but not provided, please reference and explain in a separate attachment. Application is hereby made to the Insurance Commissioner of the State of California for a reissued license to: a) Add Delete the following county(ies) to the existing license to do business as an underwritten title company: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Add Delete the authority to transact escrow business in the following county(ies): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ b) This Application is made pursuant to California Insurance Code Section 12389, et seq., and in support thereof the applicant hereby declares as follows: 1. 2. 3. Name of the applicant Address of the applicant (home office) Attached is the applicant's most recent income statement and balance sheet, verified by its chief financial officer to be true and correct. Attached is the original or reissued underwritten title company license. This license will be canceled and returned to the company concurrently with a new license, if granted. a) If the original or reissued license cannot be found, please provide an affidavit of loss. A sample affidavit is attached at the end of this application. 4. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA ­ DEPARTMENT OF INSURANCE APPLICATION FOR A REISSUED LICENSE TO ACT AS AN UNDERWRITTEN TITLE COMPANY CDI-059 (Rev. 7/2016) 5. Attached is a full and complete response to the Organizational Affidavit, executed by an executive officer authorized to sign on behalf of the underwritten title company. If the applicant is seeking to add county(ies), it must also declare the following: 6. If the applicant is requesting escrow authority, attached is either a) a surety bond in the sum of $50,000 or $100,000 depending on the proposed counties of licensure; or b) one original and one copy of the Securities Transaction Request forms (A-174), tendering deposit to the Insurance Commissioner in the sum of $50,000 or $100,000 depending on the proposed counties of licensure. The Department will forward the originals to the Securities Deposit Unit and will retain the copy for its files. i) The appropriate fee for this Securities Transaction Request has been enclosed, along with a copy of the check. 1 7. Attached are complete and duly executed copies of all existing (or unsigned copies of all proposed) underwriting agreements with any admitted title insurers under which the applicant intends to transact business in the additional county(ies). Please respond to the statements below and attach a marked-up copy of the underwriting agreements, using tabs or captions to indicate where the following required provisions are located within the agreements. a) b) c) The agreements cover all of the counties of licensure, including the counties to be added. The agreements do not allow for the placement of any liens upon the applicant. If the applicant does escrow, the agreements provide for one or more of the following provisions. Please check the appropriate boxes below: i) A fidelity bond or insurance policy in conformity with the requirements of Section 12389.6. A review of the escrow disbursements by a title insurer employee in compliance ii) 1 See the enclosed Schedule of Fees & Charges for In-State Treasury Depository. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA ­ DEPARTMENT OF INSURANCE APPLICATION FOR A REISSUED LICENSE TO ACT AS AN UNDERWRITTEN TITLE COMPANY CDI-059 (Rev. 7/2016) with the requirements of Section 12389.6. iii) An account review process in compliance with the requirements of Section 12389.6 or utilization of either the American Land Title Association's (ALTA) Escrow Internal Control Guidelines for Title Insurance Companies, Agencies and Approved Attorneys or the California Land Title Association's (CLTA) Account Review Processes and Oversight and Internal Control Guidelines as approved by the Department on April 1, 1996. Utilization of written procedures approved by the Commissioner in compliance with the requirements of Section 12389.6. iv) d) * Please note that subsection 7d (or 6d or 10d or 4) of the form has been removed as the $5000 limitation is the subject of a proposed regulation filed by the California Department of Insurance, CDI # REG-2009-00019, OAL Z-2009-0811-03. The agreements affirmatively state whether or not the applicant is authorized to handle policy claims on behalf of the title insurer. (California Insurance Code Section 790; California Code of Regulations Title 10, Chapter 5, Section 2695.2(m)) The agreements clearly indicate that the applicant is responsible for the maintenance of records regarding all escrow receipts and disbursements. (California Insurance Code Section 12389(b)) The agreements clearly indicate that the applicant is responsible for the maintenance of records of title orders sufficient to indicate their source of the orders. (California Insurance Code Section 12397.5(a)) The agreements clearly indicate that the applicant is responsible for the maintenance of adequate records regarding commissions paid, including the recipient(s) thereof, the amount(s) paid, and