"Rental Car Agency Limited License Application" - Nebraska

Rental Car Agency Limited License Application is a legal document that was released by the Nebraska Department of Insurance - a government authority operating within Nebraska.

Form Details:

  • Released on July 1, 2020;
  • The latest edition currently provided by the Nebraska Department of Insurance;
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Download "Rental Car Agency Limited License Application" - Nebraska

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PROCEDURE AND REQUIREMENTS
FOR OBTAINING AN AGENCY-RENTAL CAR
INSURANCE LICENSE
PROCEDURE
To obtain an agency Rental Car license, the NAIC Uniform Business Entity Application must be
completed and submitted to the Department of Insurance together with the following
documents:
1. A list of rental locations.
2. A list of authorized employees including full name, date of birth and
social security number.
3. A copy of the Company Training Program which includes training materials,
time outline and sign in sheet/roster.
4. Certificate from Insurer which includes:
a) Specify the kinds of insurance authorized
b) The signature of an officer of the insurer or a managing agent of the insurer
5. Copy of the contract between the Insurer and the Rental Company.
6. Brochures for renters or prospective renters as required by the Act.
7. Copy of the rental agreement forms.
8. Application fee of $50.00.
A licensee shall provide a list, updated quarterly, of all rental locations and all
employees who may act on behalf of the rental company.
LICENSE FEES
Initial License Fee ……………………….………………………….……… $50.00
Renewal Fee ………………………………….………………………………. $50.00
Late Re-issuance Fee (within 30 days after expiration) ….…. $100.00
Reinstatement fee (after 30 days and up to 12 months).... $100.00
PRINTING LICENSES
The Nebraska Department of Insurance Licensing Division no longer mails out a hard copy of
new or renewed licenses. A copy of your license can be downloaded or printed by going to:
www.statebasedsystems.com/LicensePrint.htm.
Rev 7_2020
DOI-AGCY_RENTALCAR
PROCEDURE AND REQUIREMENTS
FOR OBTAINING AN AGENCY-RENTAL CAR
INSURANCE LICENSE
PROCEDURE
To obtain an agency Rental Car license, the NAIC Uniform Business Entity Application must be
completed and submitted to the Department of Insurance together with the following
documents:
1. A list of rental locations.
2. A list of authorized employees including full name, date of birth and
social security number.
3. A copy of the Company Training Program which includes training materials,
time outline and sign in sheet/roster.
4. Certificate from Insurer which includes:
a) Specify the kinds of insurance authorized
b) The signature of an officer of the insurer or a managing agent of the insurer
5. Copy of the contract between the Insurer and the Rental Company.
6. Brochures for renters or prospective renters as required by the Act.
7. Copy of the rental agreement forms.
8. Application fee of $50.00.
A licensee shall provide a list, updated quarterly, of all rental locations and all
employees who may act on behalf of the rental company.
LICENSE FEES
Initial License Fee ……………………….………………………….……… $50.00
Renewal Fee ………………………………….………………………………. $50.00
Late Re-issuance Fee (within 30 days after expiration) ….…. $100.00
Reinstatement fee (after 30 days and up to 12 months).... $100.00
PRINTING LICENSES
The Nebraska Department of Insurance Licensing Division no longer mails out a hard copy of
new or renewed licenses. A copy of your license can be downloaded or printed by going to:
www.statebasedsystems.com/LicensePrint.htm.
Rev 7_2020
DOI-AGCY_RENTALCAR
DURATION OF LICENSE & RENEWALS
An agency Rental Car license is valid for one year from the date the license was issued.
Renewal forms and instructions are mailed to the agency approximately 90 days prior to the
expiration date of the license. When renewing the license, please include any updated training
materials and a current listing of rental locations and authorized employees.
Kinds of Insurance A Limited Licensee May Sell
A licensee may act as agent for an authorized insurer only in connection with rental vehicles
and only with respect to the following kinds of insurance:
• Motor Vehicle Liability Insurance, including uninsured and underinsured motorist
coverage that provides coverage to renters and other authorized drivers of rental
vehicles for liability arising from the operation of the rental vehicle.
• Accident and Health Insurance that provides coverage to renters and other rental
vehicle occupants for accidental death or dismemberment and for medical expenses
resulting from an accident involving the rental vehicle that occurs during the rental
period.
• Personal Property Insurance that provides coverage to renters and other rental vehicle
occupants for the loss of or damage to personal property that occurs during the rental
period
Article 40 – Rental Car Company; Limited License:
http://nebraskalegislature.gov/laws/statutes.php?statute=44-4067
Reasonable accommodations for disabled persons available
upon request at (402) 471-2201. TDD users 800-833-7352 for relay to (402) 471-2201
NEBRASKA DEPARTMENT OF INSURANCE
INSURANCE LICENSING DIVISION
P.O. BOX 82089
LINCOLN, NE 68501-2089
E-mail: DOI.Licensing@Nebraska.gov
Licensing Division: (402) 471-4913
DOI Main Line: (402) 471-2201
Fax: (402) 471-6410
Rev 7/2020
DOI-AGCY_RENTALCAR
Please note the application may be revised on a bi-annual basis. To ensure you are filing the current version of the application, please
reference the National Insurance Producer Registry web site at www.nipr.com.
Uniform Application for
Business Entity License/Registration
(Please Print or Type)
Check appropriate boxes for license requested.
Resident License
Non-Resident License
Identify Home State:_______________
o
Identify Home State License #:_____________
o
New Application
Additional Line(s) of Authority
Demographic Information
Business Entity Name
2
Incorporation/Formation Date
3
FEIN
1
(month) ___(day) ___(year) _____
-
4
If assigned, National Producer Number (NPN)
If applicable, FINRA Firm Central Registration Depository (CRD)
5
List any other assumed, fictitious, alias or trade names under which you are currently
State of Domicile
Country of Domicile
7
8
6
doing business or intend to do business.
Is the business entity affiliated with a financial institution/bank?
Yes
No
9
(Specify)
10
Business Address
11
City
12
State
Zip Code
14
Foreign Country
13
Phone Number (include Ext.)
Fax Number
Business Web Site Address
Business E-Mail Address
15
16
17
18
(
)
-
(
)
-
Mailing Address
P.O. Box
City
State
Zip Code
Foreign Country
19
20
22
23
24
21
Designated/Responsible Licensed Producer
Identify at least one Designated/Responsible Licensed Producer responsible for the business entity’s compliance with the insurance laws, rules and regulations of this
25
state. (See Matrix of State Requirements at www.nipr.com for jurisdictions that require the designated/responsible licensed producer to be an officer, director or partner
of the business entity.)
-
-
NPN _______________________
Name
SSN
-
-
NPN________________________
Name
SSN
-
-
NPN________________________
Name
SSN
-
-
NPN________________________
Name
SSN
Owners, Partners, Officers and Directors
26
Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity, or members or managers of a limited liability company:
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
Name
Title
SSN/FEIN
-
-
D.O.B ___________Owner: Yes / No % of ownership interest ____
(State Use)
© 2014 National Association of Insurance Commissioners
Page 1 of 6
Please note the application may be revised on a bi-annual basis. To ensure you are filing the current version of the application, please
reference the National Insurance Producer Registry web site at www.nipr.com.
Uniform Application for
Business Entity License/Registration
Applicant Name: _______________________________
Jurisdiction and Type of License/Registration Requested –Major Lines of Authority
27
Next to each jurisdiction, check the legal business type, license/registration type(s) and line(s) of authority for which you are applying.
LLP – Limited Liability
Legal Business Type:
C – Corporation
P – Partnership
S – Sole Proprietorship
LLC – Limited Liability Company
Partnership
License/Registration
A – Agent
B – Broker
P – Producer
SLP – Surplus Lines Producer
Types:
V – Variable
H – Accident & Health or
Lines of Authority:
L – Life
P – Property
C – Casualty
P L– Personal Lines
Life/Variable Annuity
Sickness
Jurisdiction
Legal Business Type
License/Registration Type
Lines of Authority
C
P
S
LLC
LLP
A
B
P
SLP
V
L
H
P
C
PL
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
© 2014 National Association of Insurance Commissioners
Page 2 of 6
Please note the application may be revised on a bi-annual basis. To ensure you are filing the current version of the application, please
reference the National Insurance Producer Registry web site at www.nipr.com.
Uniform Application for
Business Entity License/Registration
Applicant Name:______________________________________
Jurisdiction and Type of License/Registration - Limited Lines of Authority
28
Next to each jurisdiction, check the legal business type, license/registration type(s) and line(s) of authority for which you are applying.
LLP – Limited Liability
Legal Business Type:
C – Corporation
P – Partnership
S – Sole Proprietorship
LLC – Limited Liability Company
Partnership
License/Registration
A – Agent
B – Broker
P – Producer
SLP – Surplus Lines Producer
Types :
Limited Lines:
Credit – Credit
CR – Car Rental
CROP – Crop
T – Travel
S – Surety
O – Other: Specify Type
Jurisdiction
Legal Business Type
License/Registration Type
Lines of Authority
Specify Below
C
P
S
LLC
LLP
A
B
P
SLP
Credit
CR
Crop
T
S
O____________
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
© 2014 National Association of Insurance Commissioners
Page 3 of 6
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