Cook County, IL · Cook County
Insurance Certificate Sample B
This sample certificate shows contractors the insurance information Cook County requires for a permit and where to send the insurance certificate.
At a glance
- Issued by
- City of Cook County · Cook County, Cook County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- cookcountyil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Contractors seeking a Cook County permit can use this sample to prepare an insurance certificate that meets the Department of Transportation and Highways Permit Division requirements. It identifies coverage details, policy numbers and dates, required limits, insurer and company information, and the required certificate holder. The document also explains when an additional letter may be needed if a contractor does not own vehicles.
Who needs it
Contractors applying for a Cook County permit who must provide insurance information to the Department of Transportation and Highways need this sample.
How to submit it
Email the insurance to [email protected], as directed on the document.
About notarization
This document is signed without a notary; the signer just signs and dates the insurance certificate.
How to submit this form
- 1
Download the Sample
Download Insurance Certificate Sample B to review the county's insurance certificate requirements.
- 2
Complete the Certificate
Have the insurance certificate provide the company and insurer details, policy information, coverage, and limits shown in the sample.
- 3
Gather Any Needed Attachment
If the contractor does not own vehicles and can check only two automobile boxes, include a company-letterhead statement confirming no vehicles are owned.
- 4
Email the Insurance
Email the insurance to [email protected].
Frequently asked questions
- What is Insurance Certificate Sample B for?
- It shows contractors the insurance information and coverage limits Cook County requires for a permit, along with the required certificate holder.
- What information does the insurance certificate need?
- The sample calls for insurer and company details, policy numbers and dates, liability coverage information, and the specified coverage limits.
- How do I submit the insurance certificate?
- Email the insurance to [email protected], as directed on the document.
- Do I need a notary for Insurance Certificate Sample B?
- No. This document is signed without a notary; the signer just signs and dates the insurance certificate.