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In the fervent pursuits and operational demands faced by individuals in professions regulated under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act in Illinois, the De Ins Illinois form emerges as a fundamental document. This form acts as a supporting document necessary for the consideration of licensure or renewal under the Illinois Compiled Statutes (225 ILCS 446/1 et. seq.). It mandates the disclosure of specific information and carries the requirement for comprehensive, commercial general liability insurance tailored to the unique needs of the licensee. The form is structured to gather detailed information from the applicant, including personal identification and professional details, and from the insurance agent, who attests to the validity and coverage details of the insurance policy. Among its stipulations, it delineates the necessity for a minimum of $1,000,000 in liability insurance, which encompasses bodily injury, property damage, and personal injury, and extends to cover claims related to the use of firearms in the course of employment if applicable. The form underscores the importance of accurate and truthful completion, with both the applicant and the insurance producer affirming under penalties of perjury that the information provided is correct and that the insurance meets the mandated requirements. This dual affirmation ensures that the licensure process is grounded in a foundation of transparency and accountability, essential for the safeguarding of public interests and professional integrity within these specialized fields.

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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)

Document Attributes

Fact Detail
Form Purpose Supporting document for licensure consideration under 225 ILCS DE-INS 446/1 et. seg.
Voluntary Disclosure Disclosure of information is voluntary, but non-compliance may affect processing.
Insurance Requirement Insurance must be in the name of the individual license holder with a minimum liability of $1,000,000.
Applicant Information Applicants must complete the section with their personal and professional details.
Insurance Agent Role The authorized insurance agent must complete the remainder of the form.
Policy Specifics Coverage must include bodily injury, property damage, personal injury, and if applicable, firearm use while on duty.
Firearm Coverage Extension If licensee carries a firearm or allows employees to carry, the policy must cover related injuries or damages.
Notice of Cancellation The insurer must provide 30 days' notice to the Department of Financial and Professional Regulation before policy cancellation.
Governing Law Form is governed by Illinois Compiled Statutes 225 ILCS DE-INS 446/1 et. seg.
Form Identification IL486-1280 1/13 (DE)

How to Fill Out De Ins Illinois

Completing the DE INS Illinois form is a critical step for individuals seeking licensure or renewing licenses under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act, as codified in 225 ILCS 446/1 et seq. Failure to accurately complete and submit this form with the required license application or renewal may impede the processing of such an application. This process involves collaboration between the applicant and their authorized insurance agent to verify compliance with the state's insurance requirements, specifically relating to comprehensive commercial general liability insurance. The form also demands the disclosure of any firearms coverage if applicable. Ensuring that all provided information is accurate and submitted in a timely manner is paramount.

  1. Applicant Section:
    • Fill in your name as it appears on your license application or renewal form.
    • Enter your date of birth in the format MM/DD/YYYY.
    • Provide your Social Security Number.
    • Write down your street address, city, state, and zip code as noted on your license.
    • If you are a new applicant, refer to the reference sheet to record your profession name and three-digit profession code for which you are making the Illinois application.
    • Include your maiden or given surname if applicable.
    • For renewal applicants or those verifying current insurance, record each individual license number you hold under the specified Act.
    • Provide a daytime telephone number, including the area code.
    • Sign and date the form to certify that, to the best of your knowledge, the information provided is true, correct, and complete.
  2. Insurance Agent Section:
    • Enter the name of the insurance company providing coverage.
    • Provide the name of the authorized agency or producer.
    • List the insurance company's home office address and the agent's business address, including street, city, state, and zip code.
    • Include the insured's policy number and the title or type of policy.
    • Write down the agent's business telephone number.
    • Indicate the effective date and expiration date of the policy in the format MM/DD/YYYY.
    • Ensure that the minimum of $1,000,000 liability insurance covering bodily injury, property damage, and personal injury is included. Note any firearms coverage if relevant.
    • Sign and date the form, certifying that the policy meets Illinois requirements and that all statements made are true, correct, and complete.

Once both sections are completed, the applicant must submit this form along with their application for licensure or renewal. This submission serves as a declaration of compliance with state insurance requirements, a necessary component of licensure. It's imperative that this process is approached with accuracy and diligence to ensure a smooth licensure procedure.

More About De Ins Illinois

FAQs about the DE INS Illinois Form

  1. What is the DE INS Illinois Form?
  2. The DE INS Illinois Form is a certificate of insurance required for individuals applying for licensure or renewal under the Illinois Compiled Statutes, specifically for professions regulated under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act. This document verifies that the applicant holds a valid comprehensive, commercial general liability insurance policy.

  3. Why do I need to complete the DE INS Illinois Form?
  4. Completion of the DE INS Illinois Form is essential for verifying that you meet the insurance requirements set by the state for your professional licensure. This form provides proof of insurance coverage, which is a mandatory step in the application or renewal process for licensure in certain regulated professions in Illinois.

  5. What information is required on the DE INS Illinois Form?
  6. The form requires details such as the name of the insured exactly as it appears on the application or renewal form, date of birth, social security number, address, profession name and code, and license numbers for renewals. Additionally, the insurance agent or producer must complete sections regarding the insurance company, policy number, policy type, effective and expiration dates of the policy, and minimum liability coverage amounts.

  7. How do I obtain a DE INS Illinois Form?
  8. Typically, the DE INS Illinois Form can be obtained from the Illinois Department of Financial and Professional Regulation or its official website. It may also be available through industry associations or directly from insurance providers specializing in commercial liability insurance for professionals in Illinois.

  9. What is the minimum liability coverage required?
  10. The minimum liability coverage required as per the DE INS Illinois Form is $1,000,000. This coverage must include protection for bodily injury liability, property damage, and personal injury. Additional coverage is required for licensees who carry firearms or are in charge of an agency where employees are permitted to carry firearms during their employment.

  11. What happens if I don't complete the DE INS Illinois Form?
  12. Failure to complete the DE INS Illinois Form, or to provide accurate and valid insurance information, may result in your licensure application or renewal being denied. It's a necessary component of the compliance process for licensure in specific professions within Illinois, and missing or incorrect information can lead to delays or rejection of your application.

  13. Can I submit the DE INS Illinois Form without an insurance agent?
  14. No, part of the DE INS Illinois Form requires completion by an authorized insurance agent or producer who confirms the validity, coverage levels, and dates of the insurance policy on behalf of the insurance company. The agent’s certification and signature are crucial components of the form.

  15. What should I do if my insurance policy changes?
  16. If your insurance policy changes, it's important to update your DE INS Illinois Form with your new policy details and submit an updated version to the relevant regulatory body promptly. This ensures your professional license remains in good standing and in compliance with state insurance requirements.

  17. Is there a deadline for submitting the DE INS Illinois Form?
  18. The DE INS Illinois Form should be submitted along with your application for licensure or renewal by the specified deadline outlined by the Illinois Department of Financial and Professional Regulation. Timely submission is critical to avoid processing delays or issues with your licensure status.

Common mistakes

When completing the DE Ins Illinois form, individuals commonly make a variety of errors. Being aware of these mistakes can aid in submitting a correct and complete application, which is crucial for licensure under Illinois statutes. Below are five frequent errors:

  1. Not ensuring the name matches exactly with the application: The name of the insured must be exactly as it appears on the application or renewal form. A discrepancy in the name can cause delays or the form not being processed.
  2. Failure to include specific address: The address provided in section 4 must be specific and correspond with the address noted on the license. Vague or incorrect addresses can lead to processing issues.
  3. Omitting profession name and code for new applicants: New applicants are required to clearly record the profession name and the three-digit profession code for which licensure is sought in Illinois. Skipping this information may result in incomplete submission.
  4. Incorrect or missing policy details: Sections dealing with the insurance policy, such as the policy number, type of policy, and policy dates, must be accurately filled in. Inaccurate or missing information in these fields can invalidate the form.
  5. Neglecting to verify insurance coverage meets state requirements: The insurance coverage must meet minimum state requirements, including a minimum of $1,000,000 of liability insurance. Confirmation that the policy includes coverage for bodily injury liability, property damage, and personal injury — with additional coverage for the use of firearms, if applicable — is essential. Failure to verify these details can result in non-compliance.

In summary, paying close attention to details, ensuring accurate and complete information, and understanding the specific requirements of the DE Ins Illinois form can help applicants avoid these common mistakes. This careful approach can facilitate a smoother licensure process.

Documents used along the form

When applying for or renewing a license under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act in Illinois, the DE Ins Illinois form serves as a critical document, ensuring the applicant meets the required insurance coverage standards. Alongside this form, several other documents often complete the submission package, each playing its vital role in the application process. Understanding these documents can make the process smoother and ensure compliance with all regulatory requirements.

  • Application for Licensure or Renewal Form: This is the main form where applicants provide personal information, professional background, and the specific license they are applying for or renewing.
  • Certificate of Good Standing: For businesses or professional entities, this certificate, issued by the Secretary of State, verifies the legitimate status and compliance of the business within Illinois.
  • Proof of Fingerprint Submission: Many licensing applications require fingerprinting for background checks. This document confirms that the applicant's fingerprints were submitted and processed.
  • Background Check Authorization Form: This form gives consent to perform a criminal history check, a necessity for many professional licenses.
  • Professional Education and Training Documents: Applicants often must include transcripts, certificates, or diplomas that verify their educational background and specialized training relevant to their field.
  • Proof of Experience: Letters of recommendation or employment documents that confirm the applicant's professional experience in the related field.
  • Financial Responsibility Statement: A declaration of the applicant’s financial capability, sometimes required to ensure the applicant can responsibly manage a business or professional service.
  • Compliance Agreement Forms: These forms may be necessary to declare the applicant's commitment to adhere to state laws and regulations relevant to their profession.
  • Liability Insurance Policy Document: Besides the DE Ins Illinois form, a complete copy of the liability insurance policy, detailing coverage amounts and policy terms, reinforces the proof of insurance coverage.
  • Personal Identification: A government-issued ID, such as a driver's license or passport, to prove the identity of the applicant.

Familiarizing oneself with these documents and ensuring their accuracy and completion can facilitate a more efficient review process. While the journey to licensure may seem complex, each form and document is a step towards validating one's professionalism and commitment to meeting the state's regulatory standards. Whether you are starting this process, renewing, or updating your license, carefully compiling the necessary paperwork will support your goal to comply fully with Illinois's laws and regulations.

Similar forms

  • The Certificate of Liability Insurance form is remarkably similar to the De Ins Illinois form. Both serve as evidence of insurance coverage, explicitly outlining the insured individual's details, such as name and contact information. They detail the type of policy, the insurance company's name, policy number, effective dates, and coverage specifics. This comparison highlights their shared purpose in documenting and verifying the existence of insurance coverage to comply with regulatory requirements.

  • Similarly, the Workers' Compensation Insurance Certificate aligns closely with the De Ins Illinois form's intent and structure. It is designed to verify the policyholder's compliance with state-mandated workers' compensation insurance. Both documents necessitate the insurance agent's certification that the policy meets specific state regulations, providing crucial details like policy numbers, effective dates, and the scope of coverage, which are essential for proving compliance with state laws.

  • The Professional Liability Insurance form shares key attributes with the De Ins Illinois form, focusing on providing proof of liability coverage, particularly relevant to professionals such as doctors, lawyers, and architects. Like the De Ins Illinois form, it requires comprehensive details about the insurance policy, including the insurer and insured's names, policy limits, and coverage period, ensuring that professionals meet the licensure or regulatory standards set forth by professional boards or state laws.

  • Lastly, the Business Owners Policy (BOP) Certificate mirrors the De Ins Illinois form in its function to confirm an individual's or entity's insurance protection. Both documents are pivotal for business operation, licensing, or compliance purposes, detailing critical policy information such as the name of the insured, the insurance provider, policy numbers, and specific coverages including property damage, liability, and, if applicable, firearm use while on duty. They play a significant role in proving that businesses or individuals maintain the necessary insurance coverage as per legal or contractual obligations.

Dos and Don'ts

When filling out the DE Ins Illinois form, certain steps should be followed to ensure accuracy and compliance with Illinois state requirements. There are dos and don'ts that applicants should be mindful of, which can aid in a smooth application process for licensure or renewal of licensure under Illinois laws. Here's a list to guide you:

  • Do carefully read the entire form before beginning to fill it out, ensuring you understand all the requirements.
  • Do not overlook the section that applies specifically to either new applicants or renewal applicants. Each has distinct instructions that must be followed.
  • Do make sure that the NAME OF INSURED is exactly the same as it appears on your application or renewal form, as discrepancies could lead to processing delays.
  • Do not leave any fields blank. If a section does not apply to you, mark it with N/A (not applicable) to indicate that you have not overlooked it.
  • Do verify that the insurance policy meets the state's minimum liability coverage requirements, including specifics for bodily injury, property damage, personal injury, and, if applicable, firearms usage.
  • Do not sign the form without reviewing all the information for accuracy and completeness. Remember, submitting a form with incorrect information can be considered perjury.
  • Do have your authorized insurance agent complete their portion of the form. Their expertise can help ensure that all insurance-related information is correctly and thoroughly provided.
  • Do not forget to check the policy's effective and expiration dates. The insurance coverage must be current at the time of your application or renewal submission.
  • Do keep a copy of the completed form for your records before submitting it along with your application or renewal form. This can be valuable in the event of any discrepancies or queries from the Department of Financial and Professional Regulation.

Adhering to these guidelines can help facilitate a smoother process and reduce the likelihood of encountering obstacles in your licensure application or renewal. It is always better to be diligent and precise in filling out forms of this nature to avoid any potential issues that could impact your professional licensing.

Misconceptions

When it comes to the DE INS Illinois form, various misconceptions can lead to confusion and errors. Here's a breakdown of common misunderstandings about this important document:

  • Completing the form is optional: Although the form states that disclosing information is voluntary, not complying with its completion requirements can result in the application not being processed.
  • It's only for new applicants: Both new applicants and those seeking renewal must complete the form, as well as those verifying current insurance details.
  • Insurance can be in the business name: Insurance must specifically be in the name of the individual license holder, not the business or entity name, even if you conduct business under a separate name.
  • Any type of insurance is acceptable: The form requires comprehensive, commercial general liability insurance. This policy must cover bodily injury, property damage, and personal injury, with specific provisions if firearms are used in the course of duty.
  • The form doesn't need to be updated: If there are any changes in your insurance policy or if your policy is terminated before the expiration date, the insurer is required to notify the Department of Financial and Professional Regulation 30 days prior to cancellation.
  • Only the applicant needs to sign the form: Both the applicant/licensee and the authorized insurance agent need to sign the form, declaring under penalty of perjury that the information provided is true, correct, and complete.
  • Policy number and type aren't critical details: The policy number and type of policy are essential components of the form. Without them, verifying the insurance coverage and ensuring it meets state requirements would be challenging.
  • The form is the only document required for licensure: Completing this form is a supporting document necessary for consideration for licensure. It needs to be submitted alongside your application or renewal form, indicating that other materials are also required for the licensure process.
  • Digital submissions are acceptable: The form must be physically completed and submitted with the application or renewal form. It suggests a need for original signatures and potentially a requirement for physical submission, although digital advancements may change this in the future.

Understanding these misconceptions can help applicants ensure their forms are correctly filled out and submitted, streamlining the licensure process and avoiding potential delays. It's crucial to read the instructions carefully and provide all the required information as specified.

Key takeaways

Filling out and using the DE Ins Illinois form is a crucial step for professionals seeking licensure or renewal in certain fields within the state. Here are some key takeaways to ensure the process is completed accurately and effectively:

  • Submitting the DE Ins form is vital for licensure under the Illinois Compiled Statutes. Without this form, your application may not be processed.
  • Both the applicant and their authorized insurance agent need to complete different sections of this form. It must be submitted alongside your application for licensure or renewal.
  • The insurance policy must be under the name of the individual license holder, emphasizing the necessity of personal professional liability coverage.
  • Applicants need to provide precise personal details, including the name (as it appears on the application or renewal form), date of birth, social security number, and contact information.
  • New applicants are required to refer to a specific reference sheet to record their profession name and code correctly.
  • For those renewing their license or verifying current insurance, including all individual license numbers for professions under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act is essential.
  • The insurance policy must cover a minimum of $1,000,000 in liability, including bodily injury, property damage, and personal injury. Additional coverage is necessary if the licensee carries a firearm or is responsible for others who do while on duty.
  • The insurance provider must notify the Department of Financial and Professional Regulation at least 30 days before any policy cancellation, ensuring continuous compliance.

Proper completion and submission of the DE Ins Illinois form are foundational steps in maintaining professional licensure. This form not only certifies your compliance with state regulations but also ensures that you are covered in case of any liabilities arising from your professional activities.

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