7/01/19 to 6/30/20







As required by Section 10-101(b) of the Illinois Vehicle Code (625 ILCS 5/10-101) every employee of the State who operates a vehicle not owned, leased or controlled by the state shall procure insurance in the limit of the amounts of liability not less than the amounts required in Section 7-203 of the Act. Pursuant to Section 7-203 of the Illinois Vehicle Code (625 ILCS 5/7-203), I certify that I possess in my name auto liability insurance in at least the following amounts: $25,000 for bodily injury to or death of any one person in any one motor vehicle accident; and $50,000 for bodily injury to or death of 2 or more persons in any one motor vehicle accident: and $20,000 for injury to or destruction of property of others in any one motor vehicle accident.


As required by the Travel Regulation Council (SUBPART C Section 3000.300,(f)(1)), I CERTIFY that I am a duly licensed driver in the state of Illinois.


As stated in the State of Illinois auto liability self-insured plan administered by the Risk Management Division of CMS, I understand that if I operate my privately owned vehicle on State business and an accident occurs, my personal coverage will be PRIMARY.


If for any reason there is a change which affects the above paragraphs, I will immediately notify Travel Control of that change.



________________________________        ________________________________

Employee’s Name (please print or type)    Employee’s Signature

Form expires 6/30/20




In some cases business travel may require university employees to rent vehicles while in travel status. The State of Illinois’ Self-Insured Motor Vehicle Liability Plan provides coverage to employees of all agencies, universities, boards, and commissions not to exceed $2,000,000 per occurrence for bodily injury liability and property damage liability, while operating a state owned, leased, or controlled motor vehicle in the scope of employment. As a result of this coverage, the Travel Regulations Council has directed agencies not to reimburse travelers for additional insurances offered by rental car companies. If insurance is selected the traveler will be responsible for the cost of the insurance.