At the top of the, "Jurisdiction and Type of License/Registration Request - Limited Lines of Authority" page there is a key for abbreviations in the grid.

Just below these abbreviations, there are categories for Legal Business Type, License/Registration Type and Lines of Authority.

Find the WA grid line in the, "Jurisdiction" column.
In the, "Limited Lines of Authority" section, on the WA grid line, please write, "Specialty Producer " in the, "Other" column.

List of locations that intend to offer communications equipment insurance.
Uniform appointment form (PDF)
- You may submit the appointment with your application packet or
- Your carrier may submit electronically within 15 days from your first piece of business.
Affiliation form (PDF)
- Agency must affiliate at least one licensed individual.

For corporations or LLCs, send a copy of your articles of incorporation or formation. If you are a resident, you must also submit a Certificate of Good Standing from the Washington Secretary of State.
For firms, (a firm includes a partnership or sole proprietorship) please submit a copy of your registration with the Department of Licensing.
Sample language for premium handling authority (PDF) - Use this form if you don't have a fiduciary relationship.
Copies of available brochures or other written materials where communication equipment insurance is sold.
Copies of training and education program materials.
Certify that the policy or certificate of coverage and rates have been approved by us.

Fee Schedule

Please make checks payable to: Washington Insurance Commissioner.
You may combine all fees on one check.

License fee: $500
Appointment fee: $20/each*
Affiliation fee: $20

*Do not pay this fee to us if your carrier is submitting electronically.

Questions?

E-mail us, or

Call 360-725-7144