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De Ins Illinois Template

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.

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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

Area Code ( ___ ___ ___ ) ___ ___ ___ _ ___ ___ ___ ___

__ __ / __ __ / __ __ __ __

__ __ / __ __ / __ __ __ __

Month Day

Year

Month Day

Year

 

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)

Form Breakdown

Fact Number Description
1 The DE Ins Illinois form is a necessary supporting document for licensure consideration under 225 ILCS DE-INS 446/1 et. seq. (Illinois Compiled Statutes).
2 Completion and submission of the form are voluntary but failure to comply may result in non-processing of the form.
3 Applicants must complete a section of the form before having their authorized insurance agent complete the remainder.
4 The insurance must be in the name of the individual license holder and must cover comprehensive commercial general liability.
5 New applicants are required to note their profession name and three-digit profession code on the form.
6 Renewal applicants need to record their individual license number(s) for specific professions under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act.
7 The insurance policy must have a minimum of $1,000,000 in liability coverage, including for bodily injury, property damage, and personal injury.
8 If the licensee carries a firearm or permits employees to carry firearms in the course of duty, the policy must also cover claims for injury or damage resulting from firearm use.

Guidelines on Filling in De Ins Illinois

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:

  1. Read the IMPORTANT NOTICE at the top of the form carefully to understand the necessity and implications of the document.
  2. Under the APPLICANT section, write your full name as it appears on your application or renewal form to ensure consistency across documents (1. NAME OF INSURED).
  3. Enter your DATE OF BIRTH in the specified format: Month Day Year (2. DATE OF BIRTH).
  4. Input your SOCIAL SECURITY NUMBER carefully to ensure accuracy (3. SOCIAL SECURITY NUMBER).
  5. For your ADDRESS, include the specific street, city, state, and zip code as noted on your license (4. ADDRESS STREET, CITY, STATE, ZIP CODE).
  6. If you are a NEW APPLICANT, refer to the provided reference sheet and record the profession name and three-digit profession code (5. NEW APPLICANTS ONLY).
  7. RENEWAL APPLICANTS should list each individual license number related to the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act (6. MAIDEN OR GIVEN SURNAME and 7. RENEWAL APPLICANTS).
  8. Provide a TELEPHONE NUMBER where you can be reached during the daytime (8. TELEPHONE NUMBER).
  9. Under penalties of perjury, sign and date the form, certifying that all information provided is true, correct, and complete to the best of your knowledge.

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.

Learn More on De Ins Illinois

What is the purpose of the DE INS Illinois form?

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.

Who needs to complete the DE INS Illinois form?

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.

What information is required on the DE INS Illinois form?

Applicants and their authorized insurance agents need to provide a range of information on the form, including:

  • Applicant's name, date of birth, social security number, address, and contact number.
  • For new applicants, the profession name and code related to the Illinois application.
  • License numbers for renewal applicants and those verifying current insurance.
  • Details of the insurance policy such as the insurance company’s name, policy number, type of policy, policy effective and expiration dates, and the minimum liability coverage amount.

Is it mandatory to provide this form?

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.

What types of liability insurance coverage are required?

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.

What happens if the insurance policy is terminated before the expiration date?

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.

Common mistakes

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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

Documents used along the form

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.

  1. Application for Licensure or Renewal: This foundational document accompanies the DE Ins Illinois form, detailing the applicant’s personal information, professional history, and the specific licensure they seek. It's the starting point for the licensing process.
  2. Background Check Authorization Form: Applicants are often required to undergo a background check to verify their suitability for licensure. This form authorizes the state or a designated agency to conduct a thorough background investigation.
  3. Professional Resume or Curriculum Vitae: Provides a detailed overview of the applicant's professional experience, education, skills, and any other qualifications pertinent to the licensure being applied for. It helps the governing body assess the applicant’s readiness and suitability for professional practice.
  4. Evidence of Continuing Education: For renewal applications, this document proves the applicant has completed any required continuing education units (CEUs) or training relevant to their field, ensuring they remain knowledgeable about current practices and regulations.
  5. Employment Verification Letter: Confirms the applicant's employment history in the field for which they are seeking licensure. It may be required to verify experience levels or specific job roles pertinent to the licensure criteria.
  6. Reference Letters: Individuals applying for professional licensure might need to provide letters from professional peers or supervisors attesting to their character, work ethic, and competencies. These endorsements support the applicant’s case for being a responsible and skilled practitioner.

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.

Similar forms

  • 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.

Dos and Don'ts

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:

  • Do ensure the name of the insured matches exactly as it appears on the application or renewal form. This consistency is essential for the processing of your form.
  • Do include your social security number, date of birth, and the specific address as noted on your license to avoid any processing delays.
  • Do for new applicants, accurately record the profession name and the three-digit profession code you are applying for in Illinois.
  • Do ensure that the comprehensive commercial general liability insurance policy includes minimum liability insurance of $1,000,000, covering bodily injury, property damage, and personal injury.
  • Don't leave any sections incomplete. The form requires both the applicant and the authorized insurance agent to complete their respective sections in full.
  • Don't forget to have your insurance agent verify the policy meets the specific requirements for your licensure, including any necessary coverage related to firearm use in the course of employment.
  • Don't sign the form without ensuring all the information is accurate and true to the best of your knowledge. Submitting incorrect information can have serious implications.
  • Don't submit the form without confirming the insurance policy's effective and expiration dates, ensuring they are correct and provide the necessary coverage duration.

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.

Misconceptions

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:

  • Voluntary Disclosure: While the form indicates that the disclosure of information is voluntary, it's important to note that failure to complete the form can result in the non-processing of an application or renewal. This makes the submission less voluntary for those seeking licensure.
  • Usage of the Form: It's a misconception that this form is only applicable at the initial licensing stage. In reality, it must be completed and submitted with both initial applications and renewals for licensure.
  • Insurance Policy Name: There's a belief that the insurance can be in the business name. However, the comprehensive, commercial general liability insurance must be in the name of the individual licensee, as clearly stipulated in the form's instructions.
  • Policy Coverage: Some might think general liability insurance is enough. However, the form specifies that if the licensee carries a firearm or permits employees to carry firearms, the insurance policy must also cover claims for injury or damage from firearm use.
  • Completing the Form: A common error is thinking the applicant solely fills out the form. In reality, after the applicant completes the first section, the authorized insurance agent must fill out the rest.
  • Detail Accuracy: The belief that approximate information is sufficient is incorrect. The form specifically requires the name of the insured to match exactly as it appears on the application or renewal form.
  • Requirement of Proof: It's misunderstood that proof of insurance isn’t necessary. The form clearly states that a certificate of insurance demonstrating at least $1,000,000 in liability coverage, including specific coverage areas, must accompany the application or renewal.
  • Termination Notification: Some might not realize the insurance company is obliged to notify the Department of Financial and Professional Regulation 30 days prior to any policy cancellation, ensuring ongoing compliance.
  • New Applicants Section: There is confusion that all applicants must provide extensive historical information. New applicants only need to refer to the reference sheet for their profession code and name, streamlining the process for those at the beginning stages of licensure.

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.

Key takeaways

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:

  1. The DE Ins Illinois form is a mandatory supporting document for licensure consideration within certain professions in Illinois, demonstrating the importance of accuracy in its completion.
  2. Applicants must fill in their section before passing the document to their authorized insurance agent, highlighting a two-step process that requires attention from both parties.
  3. Insurance information must precisely match the individual license holder’s details, emphasizing the necessity for consistency across application documents.
  4. For new applicants, a reference sheet is provided to assist in recording the correct profession name and code, guiding them to provide essential information correctly.
  5. Renewal applicants are required to list every individual license number held under relevant acts, indicating the thoroughness expected in reporting current licensure.
  6. The comprehensive commercial general liability insurance policy must cover a minimum of $1,000,000, including bodily injury, property damage, and personal injury, setting a high standard for the level of protection needed.
  7. If the licensee carries a firearm or is responsible for an agency with armed personnel, the insurance must extend to cover firearm-related incidents, outlining specific coverage requirements based on professional duties.
  8. The insurance agent’s verification and signature certify that the policy meets Illinois requirements, emphasizing the role of the insurance provider in validating policy adequacy.
  9. There is an obligation for the insurance provider to notify the Department of Financial and Professional Regulation 30 days before policy cancellation, highlighting a commitment to ongoing communication and compliance.

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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