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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