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Florida diligent effort form

STATEMENT OF DILIGENT EFFORT 2026

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The document is a 'Statement of Diligent Effort' form from the Florida Surplus Lines Service Office, used by producing agents to document their attempts to obtain insurance coverage for a named insured. It requires details about the agents, the type of coverage sought, and information on authorized insurers contacted, including reasons for any declinations. The form also includes a verification section for surplus lines agents.

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Click ‘Get Form’ to open the STATEMENT OF DILIGENT EFFORT in the editor.
Begin by entering your name as the Producing Agent and your License Number in the designated fields.
Fill in the Name of Agency accurately to ensure proper identification.
In the section for Type of Coverage, specify the coverage you are seeking for the Named Insured.
List each Authorized Insurer you contacted. For each insurer, provide the Person Contacted, Telephone Number, and Date of Contact.
Document the reason(s) for declination by each insurer in the provided space to maintain a clear record.
Finally, sign as the Producing Agent and print or type your name below your signature.
Indicate whether the document has been verified by a Surplus Lines Agent and include the verification date if applicable.

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Versions	Form popularity	Fillable & printable
2017	4.2 Satisfied (26 Votes)
2006	4 Satisfied (51 Votes)
2000	4.6 Satisfied (60 Votes)

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What does diligent effort mean?

In case of a dispute regarding the disclosure of information or the terms of coverage, the statement of fact serves as a key piece of evidence. It shows what information was disclosed to the insurer at the time of policy inception.

What is a diligent effort statement?

Diligent effort means seeking coverage from and having been rejected by at least three authorized insurers currently writing this type of coverage and documenting these rejections.