Form NVL009 "Nevada Live Administrative Authorization Form" - Nevada

What Is Form NVL009?

This is a legal form that was released by the Nevada Department of Motor Vehicles - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2012;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NVL009 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form NVL009 "Nevada Live Administrative Authorization Form" - Nevada

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Nevada LIVE
DEPARTMENT OF MOTOR VEHICLES
555 WRIGHT WAY
CARSON CITY, NV 89711-0800
TELEPHONE (775) 684-4850
FAX (775) 684-4543
NvLIVEReporting@dmv.nv.gov
www.dmvnv.com
NEVADA LIVE ADMINISTRATIVE AUTHORIZATION FORM
NRS 485.314
Please refer to the Nevada LIVE Manual Specifications for the Rules of Practice for more information regarding this form.
REPORTING INFORMATION
By what date will Web Services be available? ______________ The database DMV will connect to is maintained and
controlled by
the insurance company or
a vendor.
Our company’s policy format is (please indicate alpha (A), numeric (N), or either type of character (B).)
INSURANCE COMPANY INFORMATION
Please type or print
Individual/Corporation Name
DBA Insurance Company Name
Physical Address
Street
City
State
Zip Code
Mailing Address
Street
City
State
Zip Code
Company NAIC # (only one company per form)
Administrative Contact:
First
MI
Last
Address
Street
City
State
Zip Code
(
)
(
)
Telephone Number
Fax Number
Administrator’s E-mail Address
Only one Information Technology Contact may be entered.
Information Technology Contact:
First
MI
Last
(
)
(
)
Telephone Number
Fax Number
Information Technology Contact’s E-mail Address
DMV Insurance Validation Postcards Mail to:
Name
First
MI
Last
Address
Street
City
State
Zip Code
(
)
Telephone Number
NVL009 (Rev 11/2012)
Nevada LIVE
DEPARTMENT OF MOTOR VEHICLES
555 WRIGHT WAY
CARSON CITY, NV 89711-0800
TELEPHONE (775) 684-4850
FAX (775) 684-4543
NvLIVEReporting@dmv.nv.gov
www.dmvnv.com
NEVADA LIVE ADMINISTRATIVE AUTHORIZATION FORM
NRS 485.314
Please refer to the Nevada LIVE Manual Specifications for the Rules of Practice for more information regarding this form.
REPORTING INFORMATION
By what date will Web Services be available? ______________ The database DMV will connect to is maintained and
controlled by
the insurance company or
a vendor.
Our company’s policy format is (please indicate alpha (A), numeric (N), or either type of character (B).)
INSURANCE COMPANY INFORMATION
Please type or print
Individual/Corporation Name
DBA Insurance Company Name
Physical Address
Street
City
State
Zip Code
Mailing Address
Street
City
State
Zip Code
Company NAIC # (only one company per form)
Administrative Contact:
First
MI
Last
Address
Street
City
State
Zip Code
(
)
(
)
Telephone Number
Fax Number
Administrator’s E-mail Address
Only one Information Technology Contact may be entered.
Information Technology Contact:
First
MI
Last
(
)
(
)
Telephone Number
Fax Number
Information Technology Contact’s E-mail Address
DMV Insurance Validation Postcards Mail to:
Name
First
MI
Last
Address
Street
City
State
Zip Code
(
)
Telephone Number
NVL009 (Rev 11/2012)
ADD the following Authorization Contacts:
Name(s):
Telephone Number(s)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
(
)
REMOVE the following previously authorized contacts:
Name(s):
Telephone Number(s)
(
)
(
)
(
)
(
)
In compliance with the Nevada LIVE Manual Specifications for the Rules of Practice, the insurance
company identified in the Insurance Company Information must comply with:
1. Keep specifically the beginning, ending, and lapse dates on the database, see section 3.04
Response.
2. Confirmed policies must be written specifically for Nevada, see section 3.04 Response.
3. Databases must be updated keeping up with the real time verification, see section 3.01 Service
Availability.
I declare the foregoing is true and correct and that I am the authorized person responsible for
conducting business on behalf of the named insurance company. I further declare the registered
owner information contained in queries shall not be kept in any form.
Company Name: __________________________________________________________________________________
*Administrator’s Signature __________________________________________ Date__________________________
*Please note: When changing administrators, this form must be accompanied by a letter appointing the new administrator
and signed by the company president or CEO.
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