State of Washington - Office of the Insurance Commissioner

PO Box 40255 Olympia, WA 98504-0255

I. Service Contract Provider Basic Information
1. List the exact legal name of the Service Contract Provider as registered.
2. Provide the registrant’s WAOIC# as registered.
3. Provide the name, phone, mailing address, and email for the contact person for follow up on this request.
4. If different from above, provide the name, phone, mailing address, and email for the person filing this request.

II. Lines of Business
5.The following lines of business are requested to be added:	Additional Lines Requested
Vehicle (mechanical breakdown only). Note: contracts must be approved prior to use.
Non-Vehicle (consumer goods, appliances, electronics)
Tire & Wheel
Paintless Dent Removal
Windshield chip/crack repair/replacement
Key or Key Fob replacement
Residential Utilities (Water, Sewer, etc.)

III. Supporting Documentation
Use the check box to indicate that the following information is attached to the submission:
1. Attach an updated Plan of Operation addressing the addition of the above service contracts in WA. The Plan needs to minimally address: The historical operations and any changes planned in operations due to the addition of the new business line(s). Identify who is being used to market and sell the new service contracts in WA. Clarify if there are any new marketers. Provide information on the methods of marketing utilized, and if there will be any change to the marketing plan for the new service contracts. Provide an affirmative statement that the registrant has the authority to regulate the service contract activities of each marketer, and that each marketer agrees to abide by WA law. 2. Identify the method by which the registrant intends to assure the faithful performance of its obligations under its service contracts. Note: If the registrant has been or will be issuing vehicle service contracts, it must use a reimbursement insurance policy. All contractual liabilities (including non-vehicle) will need to be consolidated and covered under one policy. Option 1: A reimbursement insurance policy issued by a qualified (as outlined in statute) insurer or risk retention group. Attach a complete copy of the policy, along with a certified statement from the carrier that the submitted policy is 1) in-force; 2) complete; 3) covers the additional lines requested; 4) provides the effective date of the coverage; and 5) is compliant with RCW 48.110.060 and all form and rate filing requirements under Chapters 48.18 and 48.19 RCW. Option 2: Maintain a funded reserve account and place a deposit with the Commissioner. Note: This option is for registrants (who have been using this option already and have a surety bond) to include only the additional NON-vehicle lines. Option 3: Registrant or parent company maintains a net worth of at least $100,000,000. Note: This option is for registrants (who have been using this option already) to include only the additional NON-vehicle lines. If using the parent company’s net worth, attach a copy of the certified guarantee required.