The De Ins Illinois form is a key document required for individuals seeking licensure or renewal under specific professional categories in Illinois, as outlined in 225 ILCS DE-INS 446/1 et. seg. This form acts as a supporting document, proving that the applicant has the necessary insurance coverage, including comprehensive commercial general liability insurance tailored to their professional needs. Mandatory for processing licensure applications, the form bridges the gap between legal compliance and professional practice.
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In the intricate landscape of professional licensure, the De Ins Illinois form emerges as a pivotal document, designed to streamline the process of obtaining or renewing a license under the strict auspices of the Illinois Compiled Statutes, specifically cited as 225 ILCS DE-INS 446/1 et. seg. This form acts as a bridge between regulatory requirements and the applicant, underscoring the necessity of holding a comprehensive commercial general liability insurance policy tailored to the licensee's professional exigencies. Applicants are tasked with providing detailed personal information, such as name, date of birth, and social security number, alongside particulars of their insurance coverage, a requirement that reinforces the commitment to professional accountability and public safety. The form meticulously outlines the need for insurance that covers not just general liability but extends to specific scenarios relevant to the licensee's field, such as bodily injury, property damage, and in certain cases, liability arising from the use of firearms in the course of their professional duties. The dual responsibility of the applicant and the insurance agent in certifying the accuracy and completeness of the information under the penalties of perjury adds a layer of verification to the process. Furthermore, the stipulation that the insurance company must notify the Department of Financial and Professional Regulation prior to any policy termination emphasizes the ongoing importance of compliance and protection throughout the licensure period. Thus, the De Ins Illinois form, by entwining regulatory compliance with insurance verification, not only facilitates a smoother licensure process but also ensures that professionals operating in sensitive sectors are adequately insured, thereby safeguarding public interest.
IMPORTANT NOTICE: Completion of this form is
SUPPORTING DOCUMENT
necessary for consideration for licensure under 225 ILCS
DE-INS
446/1 et. seg. (Illinois Compiled Statutes). Disclosure of
CERTIFICATE OF INSURANCE
this information is VOLUNTARY. However, failure to
comply may result in this form not being processed.
APPLICANT: Complete the applicant section of this form, then have your authorized insurance agent complete the remainder of the form. The completed form must be submitted WITH your application for licensure or renewal form. Insurance must be in the name of the individual license holder. The comprehensive, commercial general liability insurance must be in the name of the individual licensee.
1.
NAME OF INSURED (must be exactly as it appears on application,
2.
DATE OF BIRTH
3. SOCIAL SECURITY NUMBER
renewal form of individual license.)
__ __ / __ __ / __ __ __ __
__ __ __ - __ __ - __ __ __ __
Month Day
Year
4.
ADDRESS STREET, CITY, STATE, ZIP CODE (specific address
5.
NEW APPLICANTS ONLY
as noted on license)
REFER TO REFERENCE SHEET. Record profession name and three digit
profession code for which you are making Illinois application.
Profession Name
Profession Code
6.
MAIDEN OR GIVEN SURNAME
7. RENEWAL APPLICANTS AND PERSONS VERIFYING CURRENT
INSURANCE
ONLY -- Record each individual license number you hold
under the Private Detective, Private Alarm, Private Security, Fingerprint
Vendor, and Locksmith Act.
115 -
8.
TELEPHONE NUMBER (where you can be reached during the day-
time)
119 -
Area Code ( ___ ___ ___ ) ___ ___ ___ _ ___ ___ ___ ___
124 -
191 -
Under penalties of perjury, I declare that I have examined the policy and this completed form and to the best of my knowl- edge, the statement is true, correct, and complete.
Signature of Applicant/LicenseeDate
INSURANCE COMPANY/INSURANCE PRODUCER: Complete the following information and return the form to the applicant licensed under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act.
A. NAME OF INSURANCE COMPANY
B. NAME OF AUTHORIZED AGENCY/PRODUCER
C. INSURANCE COMPANY HOME ADDRESS:
D. NAME AND ADDRESS OF AGENT'S BUSINESS: STREET, CITY,
STREET, CITY, STATE, ZIP CODE
STATE, ZIP CODE
E. INSURED'S POLICY NUMBER
F. TITLE OR TYPE OF POLICY
G. AGENT'S BUSINESS TELEPHONE NUMBER
H. EFFECTIVE DATE OF POLICY
I. EXPIRATION DATE OF POLICY
The comprehensive commercial general liability insurance policy, with proof of a minimum of $1,000,000 of liability insurance, must include coverage for bodily injury liability, property damage and personal injury. If the licensee carries a firearm in the course of duty, coverage must extend to claims for injury or damage resulting from the use of firearms while acting in the course of employ- ment. Additionally, if the licensee serves as the licensee in charge of an agency, and the licensee in charge of that agency permits anyone associated with it to carry a firearm, then coverage must extend to claims for injury or damage resulting from the employee's use of firearms while acting in the course of employment. Under penalties of perjury, I declare that I am an autho- rized agent of the above insurance company; I have examined the policy referenced above and this application, and to the best of my knowledge, the policy meets the requirements and provides liability coverage for the licensee's operations in the State of Illinois and statements made here are true, correct and complete. If this policy is terminated prior to expiration, the insurer agrees to provide written notice to the Department of Financial and Professional Regulation thirty (30) days prior to cancellation.
Signature of Agent
Date
IL486-1280 1/13 (DE)
Filling out the DE INS Illinois form is an essential step for professionals seeking licensure or renewal of a license in specific fields within Illinois. This procedure ensures that applicants possess the required comprehensive, commercial general liability insurance, adhering to the standards imposed by Illinois law. With careful attention to detail, applicants can complete this form accurately, ensuring a smoother licensure process. Here's how to approach this form, step by step:
Once you (the applicant) have completed your portion, your authorized insurance agent must fill out the remainder of the form, including details about the insurance company, the policy, and their authorization. It's crucial to ensure that your insurance agent is well-informed about the requirements listed in the form to avoid any delays or issues with your application. After both sections are fully completed, submit this form alongside your application for licensure or renewal to comply fully with the state's regulations.
The DE INS Illinois form is a necessary supporting document for individuals seeking licensure or renewing their license under the specific regulations outlined in the 225 ILCS DE-INS 446/1 et. seq. (Illinois Compiled Statutes). It serves as a certificate of insurance, providing proof that the applicant has the required comprehensive, commercial general liability insurance. This insurance must be in the name of the individual license holder and meet the state's minimum coverage requirements.
The form must be completed by any applicant applying for a new license or renewing an existing license under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act in Illinois. It requires personal identification details from the applicant and information from the authorized insurance agent concerning the liability insurance policy.
Applicants and their authorized insurance agents need to provide a range of information on the form, including:
Yes, while the disclosure of this information is voluntary, failure to submit the completed DE INS Illinois form along with the licensure or renewal application will result in the application not being processed. It is a critical part of the documentation required for obtaining or renewing a license under relevant Illinois statutes.
The comprehensive commercial general liability insurance policy specified in the form must cover bodily injury liability, property damage, and personal injury. If the licensee carries a firearm during their duties, the coverage must extend to claims for injury or damage resulting from the use of a firearm. Furthermore, if the licensee serves as the licensee in charge of an agency that allows the carrying of firearms, the policy must also extend to include claims resulting from an employee’s use of a firearm while on duty.
If the insurance policy referenced in the form is terminated before its stated expiration date, the insurer is obligated to notify the Department of Financial and Professional Regulation at least thirty (30) days prior to cancellation. This ensures that the licensing body is aware of the change in insurance status, which is crucial for maintaining the validity of the licensee's authorization to operate within the state of Illinois.
When filling out the DE INS Illinois form, it's crucial to pay close attention to details in order to ensure the form is processed correctly and efficiently. The following list highlights common mistakes people make, which could lead to delays or difficulties in the processing of their application.
Not providing information exactly as it appears on the application or renewal form: The 'NAME OF INSURED' must match precisely with the name on your application or renewal form. Any discrepancies can cause confusion and delay the licensing process.
Forgetting to include the profession name and three-digit profession code for new applicants: The information under item 5 is crucial for new applicants as it helps categorize their application correctly. Missing details can result in incomplete processing.
Omitting individual license numbers for renewal applicants: Renewal applicants and those verifying current insurance must record each license number they hold, as noted in item 7. This helps in the verification and renewal of the correct licenses.
Providing incorrect contact information: An accurate telephone number where the applicant can be reached during the day is necessary for any clarifications or additional information requests. Incorrect or outdated contact details can significantly delay the licensure process.
Failing to confirm insurance policy details: The insurance company and the insurance producer must fill out their respective sections accurately, ensuring that the policy meets the state requirements. Overlooking vital information like the policy number, effective, and expiration dates can invalidate the application.
Not providing proof of required liability insurance: Applicants must ensure that their comprehensive commercial general liability insurance policy includes coverage for bodily injury, property damage, personal injury, and if applicable, claims related to the use of firearms. Missing documentation or inadequate coverage details could lead to non-compliance with state regulations.
To avoid these common mistakes, applicants and their insurance agents should review all sections of the DE INS Illinois form thoroughly before submission. Attention to detail ensures that the licensing process is smooth, preventing unnecessary delays or complications.
When professionals in Illinois apply for licensure or renewal under specific acts like the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act, the DE Ins Illinois form becomes essential. However, this form is commonly accompanied by several other documents to ensure a comprehensive evaluation by the Department of Financial and Professional Regulation. These documents cover a range of purposes, from establishing identity and qualifications to ensuring compliance with state laws.
Accurately completing and submitting these documents, alongside the DE Ins Illinois form, is crucial for a smooth licensure process. Each document plays a unique role in painting a comprehensive picture of the applicant, ensuring that only qualified individuals are granted the privilege to practice within Illinois' regulated fields. This meticulous documentation helps uphold the standards and safety of the profession, ultimately benefiting the community at large.
The Business License Application Form shares similarities with the De Ins Illinois form as both require detailed information about the applicant, including contact details and, in some contexts, the nature of the business or profession. Both forms are necessary steps in the process of obtaining official permission to operate within a certain field or jurisdiction.
The Professional Liability Insurance Application closely resembles the De Ins Illinois form because it collects information to verify that the applicant holds the necessary insurance coverage for their professional activities. Both documents necessitate disclosure of the insurance company, policy number, and coverage details, ensuring compliance with regulatory standards for professional conduct and protection.
Vehicle Insurance Verification Form is akin to the De Ins Illinois form in its purpose of confirming insurance coverage. While one focuses on professional liability insurance, the other verifies vehicle insurance, yet both serve as proof of insurance to a governing body or institution, fulfilling a requirement for licensure or registration.
The Workers' Compensation Insurance Affidavit parallels the De Ins Illinois form by requiring the disclosure of insurance details to confirm compliance with legal obligations. Both forms play a crucial role in safeguarding rights and responsibilities, focusing on the protection of employees in one case and professional liability in the other.
Health Insurance Enrollment Form shares the procedural aspect of insurance verification with the De Ins Illinois form. Though focusing on personal health insurance, it similarly involves submitting personal and insurance-related information to ensure coverage is in place as required by different contexts or regulations.
The Commercial Property Insurance Application is aligned with the De Ins Illinois form in the aspect of ensuring financial protection against risks. Both solicit detailed information about the insured entity and the specifications of the insurance policy, aiding in risk management for commercial entities or professional individuals.
A Risk Assessment Form used by insurance companies has a connection to the De Ins Illinois form as it evaluates the eligibility for coverage. Although primarily used internally by insurers, both forms gather critical information to determine risk profiles and the appropriateness of issuing an insurance policy or certificate.
When you're filling out the De Ins Illinois form, paying close to detail is crucial to ensure that your licensure or renewal process goes smoothly. To assist in this process, here are some helpful tips on what you should and shouldn't do:
Following these guidelines can significantly streamline the process of filling out the De Ins Illinois form, helping to ensure your application or renewal is processed without unnecessary delays.
There are several misconceptions surrounding the DE INS Illinois form that can lead to confusion. Understanding these can help in the completion and submission processes. Here's a breakdown of the common misunderstandings:
Understanding these misconceptions can greatly assist applicants in correctly completing and submitting the DE INS Illinois form, making the licensure process smoother and more efficient.
Completing the DE Ins Illinois form is essential for those applying for licensure or renewal under the specific professional categories covered by the Illinois Compiled Statutes. Here are nine key takeaways to ensure that applicants understand how to properly fill out and use this document:
Understanding these aspects of completing and submitting the DE Ins Illinois form can streamline the process, ensuring compliance with Illinois statutes and maintaining the validity of professional licensure in specialized fields.
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