Louisiana Certification of
Exempt Commercial Policyholder Status
Pursuant to Louisiana Regulation 72
The undersigned ________________________________, (the Insured) certifies to ____________________________ (the Insurer) that the Insured meets the criteria below and is an Exempt Commercial Policyholder under Louisiana law. The Insurer may issue a commercial risk insurance policy to an Exempt Commercial Policyholder without filing the policy form with the Louisiana Department of Insurance and the Insurer by signing below certifies that it has the necessary expertise to negotiate its own policy language. The policy must still comply with Louisiana law, and complaints or questions about compliance may be directed to the Louisiana Department of Insurance (1-800-259-5300).
In order to be an Exempt Commercial Policyholder, the Insured must:
__ Have and maintain aggregate annual commercial risk insurance premiums, excluding workers compensation and employer's liability and professional liability insurance premiums of more than two hundred thousand ($200,000) dollars in the preceding fiscal year. In determining whether this threshold has been met, premiums paid to one or more insurers are to be added together to reach the total aggregate.
__ At the time the policy is issued the policyholder must have (a) if a single company not less than fifty (50) employees; (b) if a member of an affiliated group not less than one hundred (100) employees collectively; (c) if a municipality a population of not less than fifty thousand (50,000); and, (d) if a public entity an operating budget of not less than twenty ($20,000,000) million dollars for the most recently completed calendar or fiscal year whichever applies.
Signed:_______________________________________
Date:_________________________________________
Printed:_______________________________________
Title:_________________________________________
Risk Manager:_________________________________
La. Admin. Code tit. 37, § XIII-9015