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 Important Information For Insurance Providers (Passenger Carriers)


This information is provided to assist insurance companies, surplus lines brokers, and agents and brokers who are authorized to sign certificates on behalf of an insurance company to make insurance filings with the License Section.


Filings should be mailed to:
California Public Utilities Commission
Attn: License Section – 2nd Floor
505 Van Ness Ave.
San Francisco, CA 94102-3298

Only original documents are accepted for filing. Fax copies will not be accepted.

Any certificate, notice of cancellation, or notice of reinstatement filed with the Commission must show the name of the insured exactly as it appears on the insured's permit, certificate or registration (or application in the case of new applicants). Check with the insured to determine how the name should appear. It is helpful if you include the carrier's Commission-assigned file number on all forms and correspondence.

If a certificate is received that does not match with a carrier name in the License Section database, the certificate will be held for a minimum of 90 days awaiting possible receipt of a new application.

Forms are to be filed either in duplicate or triplicate, as indicated on the form. If you would like to receive a date-stamped copy of the form, enclose a stamped, self-addressed envelope with your filing.

With the exception of certificates filed for vessel carriers and air carriers, certificates are good until canceled. To cancel a certificate, you must give the Commission 30 days' notice on an authorized form, the 30 days to commence to run from the date notice is actually received in the Commission's San Francisco office.

Obtaining Forms

For security reasons, we do not make insurance forms available for downloading. You may write to the License Section on your letterhead to request a sample form. Please note that forms are color-coded and must be reproduced or printed in the correct color to facilitate processing. Some forms are available commercially in large quantity from Uniform Information Services, Inc.

Workers' Compensation Coverage

Workers' compensation filings for passenger stage corporations, charter-party carriers, and household goods carriers are made using certificate of insurance Form TL 938 (cancellation notice = Form TL 944; reinstatement notice = Form TL 945).  [Info Sheet--Employees and Workers Comp Codes]

Insurance Forms for Interstate Registration

For-hire motor carriers of passengers conducting interstate operations must register their interstate (federal) operating authority with the Commission through the Single State Registration System (SSRS). To complete SSRS registration the motor carrier must file a copy of the proof of insurance that was filed with the Federal Motor Carrier Safety Administration to obtain and maintain federal operating authority.

Table of Forms

The table below shows the forms used to make liability insurance filings. If the table shows a standard form of endorsement associated with the certificate of insurance, you are responsible for attaching a completed endorsement to the insured's policy. It should not be filed with the Commission.


Passenger Stage Corporation, or PL 914 Certificate PL 912
Charter-party Carrier PL916 Cancellation  
  PL917 Reinstatement  
Household Goods Carrier (Liability) TL 676 Certificate TL 675-A
  TL 394 Reinstatement  
  TL 568 Cancellation  
Household Goods Carrier (Cargo TL 672 Certificate TL 671
  TL 673 Cancellation  
  TL 674 Reinstatement  
Private Carrier TL 1000 Certificate TL 1003
  TL 1001 Reinstatement  
  TL 1002 Cancellation  
Transportation incidental to operation TL 1010 Certificate TL 1009
of a youth camp that is required to TL 1001 Reinstatement  
register as a Private Carrier TL 1002 Cancellation  
Vessel Common Carrier PE 717 Certificate N/A
For-hire Vessel Carrier PE 793 Certificate N/A


Last Modified: 7/6/2015

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