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FORM_NUM VERSION
OIR-B1-1682/1683 1
Thank you for your data submission.
If you need any assistance during the filing process,
please contact the
Market Research Unit’s Data Collection and Analysis Section at
TitleInsuranceExperienceReporting-Agency@fldfs.com
(850) 413-3146
COLUMN A COLUMN B
For verification purposes,
please select the filing Selected Year
year from the list below
2001
2002
2003 2001
2004
2005
AGENCY NAME:
FLORIDA LICENSE NUMBER:
FEDERAL EMPL ID:
ADDRESS:
CITY:
STATE:
ZIP CODE:
CONTACT PERSON:
Select Florida counties
where the agency Selected County
operates
STATEWIDE
ALACHUA
BAKER
BAY
BRADFORD
BREVARD
BROWARD
CALHOUN
CHARLOTTE
CITRUS
CLAY
COLLIER
COLUMBIA
DE SOTO
DIXIE
DUVAL
ESCAMBIA
FLAGLER
FRANKLIN
GADSDEN
GILCHRIST
GLADES
GULF
HAMILTON
HARDEE
HENDRY
HERNANDO
HIGHLANDS
HILLSBOROUGH
HOLMES
INDIAN RIVER
JACKSON
JEFFERSON
LAFAYETTE
LAKE
LEE
LEON
LEVY
LIBERTY
MADISON
MANATEE
MARION
MARTIN
MIAMI-DADE
MONROE
NASSAU
OKALOOSA
OKEECHOBEE
ORANGE
OSCEOLA
PALM BEACH
PASCO
PINELLAS
POLK
PUTNAM
SANTA ROSA
SARASOTA
SEMINOLE
ST JOHNS
ST LUCIE
SUMTER
SUWANEE
TAYLOR
UNION
VOLUSIA
WAKULLA
WALTON
WASHINGTON
COLUMN C COLUMN D COLUMN E COLUMN F COLUMN G COLUMN H COLUMN I COLUMN J COLUMN K COLUMN L COLUMN M
REPORTING YEAR 2001 ACTIVITY
EXPERIENCE REPORT
AGENCY AGENCY EXPERIENCE REPORT TITLE ALL ACTIVITIES RTS PROVIDED TO RTS PROVIDED TO RTS PROVIDED TO
ALL ACTIVITIES
Trade LOSS PTS MARKETING EXCLUDING RTS & TITLE CLIENTS TITLE CLIENTS NON-TITLE MISC. ACTIVITIES
Secret
PART 1 - INCOME STATEMENT ($,000
PART 1 - INCOME STATEMENT
FUNDING (2) (3) MISC. (CLOSING & (ALL OTHER) CLIENTS (8)
(9) = SUM
OMITTED) ($,000 OMITTED) 4,5,6,7,8
(1) (4) = SUM 1,2,3 ESCROW) (5) (6) (7)
REVENUE
1. TOTAL TITLE INSURANCE PREMIUMS 0
2. PREMIUM REMITTED TO INSURER 0
3. PREMIUM RETAINED BY AGENT (1 MINUS 2) 0 0
4. PRODUCTION REVENUES
A. SEARCH 0
B. EXAMINATION 0
C. CLOSING & ESCROW 0
5. OTHER REVENUE 0
6. TOTAL REVENUE (SUM 3 THROUGH 5) 0 0 0 0 0 0
INTERNAL EXPENSE
7. TITLE LOSS & LOSS ADJUSTMENT EXPENSE INCURRED
A. POLICYHOLDER CLAIMS - LOSSES & ALAE
B. POLICYHOLDER CLAIMS - ULAE
C. NON-POLICYHOLDER CLAIMS - LOSSES & LAE 0
8. INCREASE IN TITLE STATUTORY PREMIUM RESERVE
9. TITLE PLANT RENT AND MAINTENANCE (INTERNAL) 0 0
10. PERSONNEL COSTS
A. SALARIES - EMPLOYEES 0 0
B. SALARIES - OWNERS/PARTNERS 0 0
C. EMPLOYEE BENEFITS - EMPLOYEES 0 0
D. EMPLOYEE BENEFITS - OWNERS/PARTNERS 0 0
E. PAYROLL TAXES 0 0
F. EMPLOYEE EDUCATION 0 0
G. OTHER PERSONNEL COSTS 0 0
H. SUBTOTAL (SUM A THROUGH G) 0 0 0 0 0 0 0 0
11. REAL ESTATE MAINTENANCE & SECURITY (INTERNAL) 0 0
EXTERNAL EXPENSE
12. TITLE PLANT RENT AND MAINTENANCE (EXTERNAL) 0 0
13. ADVERTISING, MARKETING & PROMOTIONAL 0 0
14. REAL ESTATE (NON-OWNED)
A. RENTAL EXPENSE 0 0
B. MAINTENANCE, SECURITY, INS, ETC. (EXTERNAL) 0 0
15. REAL ESTATE (OWNED)
A. DEPRECIATION/MORTGAGE EXPENSE 0 0
B. MAINTENANCE, SECURITY, INS, ETC. (EXTERNAL) 0 0
C. TAXES 0 0
16. TRAVEL
A. AIR TRAVEL 0 0
B. LODGING 0 0
C. MEALS & ENTERTAINMENT 0 0
D. AUTOMOBILE RENTAL (INCL. INS) 0 0
E. TAXI / TRAIN / BUS / OTHER TRAVEL 0 0
17. EQUIPMENT DEPRECIATION/LEASE & RELATED EXPENSE
A. ELECTRONIC DATA PROCESSING 0 0
B. AUTOMOBILE 0 0
C. OTHER EQUIPMENT (PRICE > $1000) 0 0
18. OFFICE SUPPLIES & PRINTING 0 0
19. POSTAGE, TELEPHONE, MESSENGER & EXPRESS 0 0
20. TITLE FEES - SEARCH/ABSTRACT
A. PAID TO TITLE AGENTS 0 0
B. PAID TO INSURERS 0 0
C. PAID TO OTHERS 0 0
21. TITLE FEES - EXAM
A. PAID TO TITLE AGENTS 0 0
B. PAID TO INSURERS 0 0
C. PAID TO OTHERS 0 0
22. TITLE FEES - SURVEY & OTHER PRODUCTION SERVICES
A. PAID TO TITLE AGENTS 0 0
B. PAID TO INSURERS 0 0
C. PAID TO OTHERS 0 0
23. CLOSING & ESCROW FEES
A. PAID TO TITLE AGENTS 0 0
B. PAID TO INSURERS 0 0
C. PAID TO OTHERS 0 0
24. INSURANCE EXPENSE
A. E&O & BONDING 0 0
B. OTHER (EXCL. AUTOMOBILE & PROPERTY) 0 0
25. TAXES, LICENSES & FEES (EXCL. REAL ESTATE TAX & FIT)
A. NON-POLICYHOLDER 0 0
B. RECORDING, TAX CERTIFICATE, & INSPECTION FEES 0 0
26. BOARDS & BUREAUS 0 0
27. TRADE CLUBS/ASSOCIATIONS 0 0
28. DIRECTORS' FEES 0 0
29. LEGAL EXPENSE (NON-POLICYHOLDER) 0 0
30. ACCOUNTING/AUDITING 0 0
31. INTEREST EXPENSE 0 0
32. BAD DEBT EXPENSE (NET OF RECOVERIES) 0 0
33. BUSINESS START-UP EXPENSE 0 0
34. BUSINESS FAILURE EXPENSE 0 0
35. AGGREGATE WRITE-INS FOR MISC. EXPENSES 0 0
TOTAL EXPENSE
36. TOTAL EXPENSES INCURRED (SUM 7 THROUGH 35) 0 0 0 0 0 0 0 0
PROFIT
37. NET PROFIT/(LOSS) BEFORE TAX (6 MINUS 36) 0 0 0 0 0 0
C
COLUMN NOLUMN O COLUMN P COLUMN Q COLUMN R COLUMN S COLUMN T COLUMN U COLUMN V COLUMN W COLUMN X COLUMN Y
REPORTING YEAR 2001 Totals from Part1, Line2 Totals from Part1, Line3 Totals from Part1, Line1 Reconciliati
AGE
AGENCY EXPERIENCE REPORT 0 0 0
PART 2 - PREMIUM BROKEN DOWN BY INSURER
NCY
($,000 OMITTED) TITLE PREMIUMS TITLE PREMIUMS
NAIC COMPANY
CODE FOR
Name of Each Insurer For Which This Agency PREMIUM BALANCES
Trade INSURER LISTED REMITTED RETAINED TOTAL
Wrote Premiums OWED
Secret IN PREVIOUS (3) (4) (5)
(1) (6)
COLUMN
(2)
Total 0 0% 0 0% 0 0% 0
COLUMN AA
COLUMN Z COLUMN AB COLUMN ACCOLUMN AD COLUMN AE COLUMN AF COLUMN AG COLUMN AH COLUMN AI COLUMN AJ COLUMN AK COLUMN AL
REPORTING YEAR 2001 Totals from Part1, Line5 Totals from Part1, Line5 Totals from Part1, Line5 Totals from Part1, Line5 Totals from Part1, Line5 Totals from Part1, Line5 Reconciliation to Part 1
0 0 0 0 0 0
ACTIVITY ACTIVITY
AGENCY EXPERIENCE REPORT TITLE
ALL ACTIVITIES RTS PROVIDED TO TITLE RTS PROVIDED TO TITLE RTS PROVIDED TO NON-
Trade LOSS PTS MARKETING MISC. ACTIVITIES ALL ACTIVITIES
Secret
PART 3 - OTHER REVENUE ($,000 FUNDING (2) (3)
EXCLUDING RTS & MISC. CLIENTS (CLOSING & CLIENTS (ALL OTHER) TITLE CLIENTS
(8) (9) = SUM 4,5,6,7,8
(4) ESCROW) (5) (6) (7)
OMITTED) (1)
ITEMIZE "OTHER REVENUE"
TOTAL 0 0 0 0 0 0
1. Investment Income (Due to Delayed Premium Remittance) 0
2. Investment Income (All Other) 0
3. Abstracting 0
4. Underwriting Inspection Fees 0
5 In-house Copy, Express & Other Fees 0
6. Recording Fees 0
7. Tax Certificates 0
8 Termite, Building & Other Inspection Fees 0
9. Other (itemize)
AM
COLUMNCOLUMN AN COLUMN AO COLUMN AP
REPORTING YEAR 2001
AG
AGENCY EXPERIENCE REPORT
EN 4 - OTHER CONSIDERATION PAID TO OWNERS & PARTNERS
PART
CY
Trade OTHER CONSIDERATION PAID TO OWNERS
AMOUNT ($,000 OMITTED)
Secret & PARTNERS
TOTAL 0
1. Directors Fees
2. Exam Fees
3. Search Fees
4. Closing & Escrow Fees
5. Management Fees
6. Rents
7. Interest
8. Other (itemize)
COLUMN AQ COLUMN AR COLUMN AS COLUMN AT COLUMN AU COLUMN AV COLUMN AW COLUMN AX COLUMN AY COLUMN AZ COLUMN BA
REPORTING YEAR 2001 Totals from Part1, Line7CTotals from Part1, Line7CTotals from Part1, Line7CTotals from Part1, Line7CTotals from Part1, Line7C Reconciliation to Part1
0 0 0 0 0
ACTIVITY ACTIVITY
AGENCY EXPERIENCE REPORT TITLE RTS PROVIDED TO RTS PROVIDED TO
MARKETIN ALL ACTIVITIES RTS PROVIDED TO NON-
Trade PART 5A - LOSS & LOSS ADJUSTMENT LOSS PTS TITLE CLIENTS TITLE CLIENTS (ALL MISC. ACTIVITIES ALL ACTIVITIES
G EXCLUDING RTS & MISC. TITLE CLIENTS
Secret EXPENSES INCURRED BY AGENT FUNDING (2) (CLOSING & ESCROW) OTHER) (8) (9) = SUM 4,5,6,7,8
(3) (4) (7)
(1) (5) (6)
($,000 OMITTED)
LOSS AND LOSS ADJUSTMENT EXPENSE
INCURRED BY AGENT (NET OF RECOVERIES
1. CLOSING & ESCROW
FROM INSURERS) LOSSES 0
2. AGENT SEARCH & EXAM LOSSES 0
3. ALL OTHER LOSSES 0
4. LOSS ADJUSTMENT EXPENSE 0
TOTAL 0 0 0 0 0 0
BC
COLUMNCOLUMN BD COLUMN BE COLUMN BF COLUMN BG
REPORTING YEAR 2001
AGENCY EXPERIENCE
AGENCY EXPERIENCE REPORT
REPORT
PART - - LOSS & LOSS
PART 5B5B LOSS & LOSS ADJUSTMENT EXPENSES INCURRED BY AGENT
ADJUSTMENT EXPENSES
Trade LOSS AMOUNT ($,000 LOSS ADJUSTMENT EXPENSE
DATE OF PAYMENT
Secret OMITTED) AMOUNT ($,000 OMITTED)
ITEMIZATION OF LOSS LOSS ADJUSTMENT EXPENSE
ITEMIZATION OF LOSS && LOSS ADJUSTMENT EXPENSE PAYMENTS
TOTAL 0 0
COLUMN BI
COLUMN BH COLUMN BJ COLUMN BK COLUMN BL COLUMN BM COLUMN BN COLUMN BO COLUMN BP COLUMN BQ COLUMN BR COLUMN BS
REPORTING YEAR 2001 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Total from Part1, Line35 Reconciliation
0 0 0 0 0 0 0 0
ACTIVITY ACTIVITY
AGENT'S EXPERIENCE REPORT
AGENCY EXPERIENCE REPORT ALL ACTIVITIES RTS PROVIDED TO RTS PROVIDED TO
PART 6 - MISC. EXPENSES Round to the TITLE LOSS RTS PROVIDED TO
Trade PART 6 - MISC. EXPENSES PTS MARKETING EXCLUDING RTS & TITLE CLIENTS TITLE CLIENTS (ALL MISC. ACTIVITIES ALL ACTIVITIES
Nearest the Nearest Dollar)
(Round toDollar
FUNDING NON-TITLE CLIENTS
Secret (2) (3) MISC. (CLOSING & ESCROW) OTHER) (8) (9) = SUM 4,5,6,7,8
(1) (7)
(4) = SUM 1,2,3 (5) (6)
ITEMIZE "MISC." EXPENSES
TOTAL ($,000 OMITTED) 0 0 0 0 0 0 0 0
COLUMN BU COLUMN BV COLUMN BW COLUMN BX COLUMN BY COLUMN BZ COLUMN CA COLUMN CB
REPORTING YEAR 2001
AGENCY EXPERIENCE REPORT
Trade
Secret PART 7 - RESIDENTIAL VS.
COMMERCIAL SPLIT
TOTAL TITLE INSURANCE PREMIUMS OMITTED)
TOTAL TITLE INSURANCE PREMIUMS ($,000($,000 ACTUAL NUMBER TRANSACTIONS OR POLICIES ISSUED
ACTUAL NUMBER OF OF TRANSACTIONS OR POLICIES
TYPE OF TRANSACTION OR POLICY ISSUED
RESIDENTIAL COMMERCIAL TOTAL RESIDENTIAL COMMERCIAL TOTAL
1. Original Owners & Leasehold Policies 0 0
2. Single Issue Lender's Policies 0 0
3. Construction Loan Policies 0 0
4. Search or Abstract Without Policy Issued by Agent 0 0
TOTAL 0 0 0 0 0 0
COLUMN CC COLUMN CD COLUMN CE
REPORTING YEAR 2001
AGENCY EXPERIENCE REPORT
PART 8A - RECONCILIATION
Trade
Secret OF REPORTED NET INCOME
TO BOOK INCOME & TAXABLE
INCOME ($,000 OMITTED)
1. Net Income per Part 1 0
2. Adjustments for book income 0
a. Charitable contributions
b. Political contributions and lobbying
c. Penalties
d. Depreciation
e. Income tax expense
f. Other (attach itemized schedule)
3. Subtotal 1 and 2 0
4. Book Income
5. Book/tax adjustments 0
a. Depreciation - tax adjustments
b. 50% of meals & entertainment
c. Carry-overs/Carry-backs
d. Capital gains or losses
e. Tax exempt income
f. Other. Please submit an itemized
schedule by submitting
supplementary information per
instructions provided in Title
Insurance Experience Reporting
Instructions.
6. Subtotal 4 and 5 0
7. Taxable Income
COLUMN CF COLUMN CG COLUMN CH COLUMN CI COLUMN CJ COLUMN CK
REPORTING YEAR 2001
AGENCY EXPERIENCE REPORT
PART 8B CONVERSION WORKSHEET - RECONCILIATION OF
REPORTED NET INCOME TO BOOK INCOME & TAXABLE
INCOME ($,000 OMITTED)
Months Included In
Most Recent Fiscal Months After Last
Trade FISCAL YEAR WORKSHEET Prior Experience Total
Year Fiscal Year
Secret Used to convert to a calendar year basis, if necessary. Report (4) = 1 + 2 - 3
(1) (2)
(3)
Total revenue
Total expense
Total income
CL
COLUMN COLUMN CM COLUMN CN COLUMN CO COLUMN CP
REPORTING YEAR 2001
COMMENTS:
Trade Response ListResponse List If more space is needed, please provide by
Agency Questionnaire comments
submitting supplementary information per
Secret Select from the list provided. instructions provided in Title Agency
Experience Reporting Instructions.
1 Affiliation (select all applicable) Minority ownership by an insurer.
Minority ownership of an insurer.
Majority ownership by an insurer.
Majority ownership of an insurer.
Part ownership by a realtor or real
estate agency.
Part ownership by a real estate
developer.
Part ownership by a mortgage
Law firm.
None of the above (use the next
column to explain).
2 If there is any ownership by an insurer or of an
insurer, are there any insurer operations on Ownership by an insurer.
site? (select all applicable) Ownership of an
Does not apply.
Policy service.
Underwriting.
Claims.
Other (use the next column to
3 In reference to the item above, are shared
Does not apply.
expenses by your company fully reimbursed? Yes, using GAAP cost allocations.
(select all applicable) Yes, using management or service
contracts.
No (use the next column to explain).
4 Some title agencies share facilities, employees, Does not apply
None
supplies, etc. with other non-title business Attorney / law allocations
Yes, using GAAP cost firm
activities. Indicate any operation your agency Lending Institution
shares with a non-title operation. (select all Real Estate Broker
applicable)
Survey /Engineering
Tax Service
Other (use the next column to
5 How do you allocate expenses among the types
Direct Basis
of operations shown in Agent's Experience
Report? Please select each allocation method Square Footage
used. Time Studies
Gross revenues
Assets
Other (use the next column to
6 Has the agency commenced operations, ceased
No
operations or merged with another entity
during the reporting year? Yes(use the next column to
7 Tax year ending date
8 Tax status at year end. (select only one)
C-corporation
S-corporation
General Partnership
Limited Liability Partnership
Sole Proprietor
Other (use the next column to
explain)------------------------->
9 Did a CPA prepare the Agency Experience
Report provided?
Yes
No(use the next column to
explain)------------->
10 Does the Agent’s Experience Report reconcile
No
to the agency’s Federal Income Tax return?
Yes(use the next column to
explain)------------->
11 What is the basis of depreciation of assets used
in the Agency Experience Report? (Select as Same as Federal Income Tax
applicable.) Cash basis (no depreciation)
Other (use the next column to
12 Regarding “Investment Income (Due to Delayed (a) Investment Income (Due to Delayed
Premium Remittance)” from Part 3 of the Premium Remittance)
Agency Experience Report, please provide the (b) Average Agents Balances over
information shown. Course of Year
(c) Average Before-Tax Rate of Return
on Funds
Premium Remittance)” from Part 3 of the
Agency Experience Report, please provide the
information shown.
(d) Average Remittance Delay (in Days)
[= a / (b x c) x 365]
13 Are there any unusual events or features of
No
your data submission that may have an impact
on its usefulness for Florida title insurance Yes(use the next column to
rate determination? explain)------------->
14 Pursuant to Rule 69O-186.003, F.A.C.,
Florida’s original title insurance rates Too Much
currently grade downward as the amount of
insurance increases from less than $100,000 to Too Little
over $10 million. In reflecting the relative
amount of expense and loss potential, do you Just Right
believe that the current amount of downward
gradation is too much, too little, or just right?
Please attempt to quantify if possible. Also,
please comment similarly on the amount of
gradation currently represented in the reissue
rates, using the Comments column on the right
15 What changes would you recommend to the
current rates for the various title None
endorsements currently in use in Florida? I would change..(use the next
column to explain)--------------->
16 What changes would you recommend to the
Agency Experience Report? Please enter
response in Comments column.
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