C CC1 (Rev 3-21) Certification of Coverage for Limited Liability Companies Per California Insurance Code Section 1647.5 For purposes of satisfying the security requirements of California Insurance Code (Cal. Ins. Code) Section 1647.5, all Limited Liability Companies must provide evidence of financial security compliance. Limited Liability Companies, once licensed, must also file with the Commissioner an annual confirmation of coverage demonstrating continued compliance with the financial secur.
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How to fill out the CA LIC CC1 online
The CA LIC CC1 form is crucial for Limited Liability Companies in California to demonstrate compliance with financial security requirements. This guide will provide you with step-by-step instructions to fill out this form effectively online.
Follow the steps to complete the CA LIC CC1 form online.
- Click the ‘Get Form’ button to obtain the document and open it in your online editor.
- In the first section, enter the 'Insured Name,' which should be the legal name of the insurance company providing coverage.
- Next, fill in the 'License Number' associated with the insurance company, followed by the 'Policy Number' of the coverage being referenced.
- Provide the 'Policy Effective Date' and the 'Policy Expiration Date' to indicate the duration of the insurance coverage.
- In the 'LLC Company Name' field, write the name of the Limited Liability Company that is being insured.
- Enter the complete address of the LLC, including the street, city, state, and zip code.
- Specify the 'Insurance Company' name again here for clarity.
- Indicate if this is a 'Blanket Policy' or 'Individual Policy' by checking the appropriate box.
- Specify the number of licensees rendering professional services that are covered under this insurance policy.
- Finally, the representative of the insurance company must provide their signature, date, and title, ensuring the signature is from someone who is not a member, manager, or officer of the LLC.
- Once all fields are completed, you can save the changes, download or print the form, or share it as necessary.
Complete your CA LIC CC1 form online today to ensure your compliance!
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