STUDENT’S
CERTIFICATION - PRIVATELY OWNED VEHICLES
DATE:_________________
As required by Section 10-101 (b)
of the Illinois Vehicle Code (625 ILCS 5/10-101) every student 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; $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 Business Services
of that change.
____________________________________________
____________________________________________
Student’s Name (please print or
type) Student’s
Signature
Expires 6/30/2020