Insurance Certificates For Van Pool Vehicles

STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin PC-41 December 20, 2000 TO ALL COMPANIES LICENSED IN THE STATE OF CONNECTICUT TO WRITE AUTOMOBILE LIABILITY INSURANCE RE: Insurance Certificates for Van Pool Vehicles \ This bulletin contains guidelines and procedures for Insurance Certificates for Van Pool Vehicles required pursuant to Connecticut General Statute. Bulletin PC-41 consolidates and updates information from the superseded and archived Connecticut Insurance Department bulletins NF-59 and NF 104. 1. V ANPOOL CERTIFICATE REQUIRED The owner ofa vanpool vehicle must submit evidence to the Commissioner ofMotor Vehicles that the vehicle is covered by a policy ofinsurance or bond which indemnifies the insured against any legal liability for personal injury, death or property damage caused by the use or operation ofthe vanpool vehicle. The minimum amount ofcoverage required is $350,000 per accident. The V anpool Certificate language and format shown in number 3 below is acceptable to the Department of Motor Vehicles as evidence ofrequired coverage. It must be submitted to the Department ofMotor Vehicles in duplicate, both on letterhead ofthe insurance company providing the coverage. The Department ofMotor Vehicles will return one copy to the company address indicated. 2. TERMINATION OF A V ANPOOL CERTIFICATE A vanpool certificate may be cancelled by use ofthe Connecticut Special Notice of Cancellation or Termination Form IRB3616D. Cancellation must be received by the Department ofMotor Vehicles 30 days prior to the effective date oftermination. Coverage will terminate on the effective date ofcancellation or termination, on the date the insured surrenders the vanpool registration, or on the effective date of replacement certificate, whichever is earlier. www.state.ct.us/cid/ P. 0. Box 816 Hartford, CT 06142-0816 Page 1 of2 An Equal Opportunity Employer 3. CONNECTICUT V ANPOOL INSURANCE CERTIFICATE CONNECTICUT V ANPOOL INSURANCE CERTIFICATE Date Last Name ofRegistered Owner First Name IMiddle Name Name oflnsured ' Address Current Policy No Effective From I I Description ofVehicle: I All owned or operated V anpool vehicles Limit ofLiability Blanket coverage ofnot less than $350,000 for personal injury, death and property damage Year and Make ofVehicle Identification No Passenger Capacity Pursuant to Section 14-27A ofthe Connecticut General Statutes, 1985 Revision, as amended, the company signatory hereto certifies that it has issued a Policy ofInsurance covering the owner's liability for the vehicle designated above which is used as a V ANPOOL VEHICLE This certificate is effective from __ and continues in effect until after thirty days' written notice to the Department ofthe cancellation or termination ofthe policy or renewals Name oflnsurance Company By: Signature ofAuthorized Representative h~.!.~u&R Insurance Commissioner