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.
Procedures
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., 1-800-382-2424.
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.
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|
|
| CARRIER TYPE |
INSURANCE FORMS |
ENDORSEMENTS |
| 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 |