West Virginia Code § 33-12C-12

Evidence of the insurance and subsequent changes to the insurance
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(a) Upon placing surplus lines insurance, the surplus lines licensee shall promptly deliver to
the insured the policy, or if the policy is not then available, a certificate as described in
subsection (d) of this section, cover note, binder or other evidence of insurance. The
certificate described in subsection (d) of this section, cover note, binder or other evidence of
insurance shall be executed by the surplus lines licensee and shall show thee description and
location of the subject of the insurance, coverages including any material limitations other
than those in standard forms, a general description of the coverages ofr the insurance, the
premium and rate charged and taxes to be collected from the insured, and the name and
address of the insured and surplus lines insurer or insurers and proportion of the entire risk
assumed by each, and the name of the surplus lines licensee and the licensee's license
number. t
(b) A surplus lines licensee shall not issue or deliver any evidence of insurance or purport to
insure or represent that insurance will be or has been written by any eligible surplus lines
insurer, or a nonadmitted insurer pursuant to subdivision (4), subsection (c), section five of
this article, unless the licensee has authority fsrom the insurer to cause the risk to be insured,
or has received information from the insurer in the regular course of business that the
insurance has been granted.
(c) If, after delivery of any evidence of insurance, there is any change in the identity of the
insurers, or the proportion of tehe risk assumed by any insurer, or any other material change
in coverage as stated in the surplus lines licensee's original evidence of insurance, or in any
other material as to the Linsurance coverage so evidenced, the surplus lines licensee shall
promptly issue and deliver to the insured or the original producing individual insurance
producer appropriate substitute for, or endorsement of the original document, accurately
showing the current status of the coverage and the insurers responsible for the coverage.
(d) As soon as reasonably possible after the placement of the insurance, the surplus lines
liceWnsee shall deliver a copy of the policy or, if not available, a certificate of insurance to the
insured to replace any evidence of insurance previously issued. Each certificate or policy of
insurance shall contain or have attached a complete record of all policy insuring
agreements, conditions, exclusions, clauses, endorsements or any other material facts that
would regularly be included in the policy.
(e) A surplus lines licensee who fails to comply with the requirements of this subsection shall
be subject to the penalties provided in this article.
(f) The surplus lines licensee shall give the following consumer notice to every person
applying for insurance with a nonadmitted insurer. The notice shall be printed in sixteen-
point type on a separate document affixed to the application. The applicant shall sign and
date a copy of the notice to acknowledge receiving it. The surplus lines licensee shall
maintain the signed notice in its file for a period of ten years from expiration of the policy.
The surplus lines licensee shall tender a copy of the signed notice to the insured at the time
of delivery of each policy the licensee transacts with a nonadmitted insurer. The copy shall
be a separate document affixed to the policy.
"Notice: 1. An insurer that is not licensed in this state is issuing the insurance policy that you
have applied to purchase. These companies are called "nonadmitted" or "surplus lines"
insurers. 2. The insurer is not subject to the financial solvency regulation and enforcement
that applies to licensed insurers in this state. 3. These insurers generally doe not participate
in insurance guaranty funds created by state law. These guaranty funds will not pay your
claims or protect your assets if the insurer becomes insolvent and is unrable to make
payments as promised. 4. Some states maintain lists of approved or eligible surplus lines
insurers and surplus lines brokers may use only insurers on the lists. Some states issue
orders that particular surplus lines insurers cannot be used. 5. For additional information
about the above matters and about the insurer, you should atsk questions of your insurance
agent or surplus lines licensee. You may also contact your Insurance Commission consumer
help line."

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