2017 Motor Vehicle Theft Prevention Trust Fund Insurer Worksheet

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ILLINOIS MOTOR VEHICLE THEFT PREVENTION COUNCIL
300 West Adams Street, Suite 200, Chicago, Illinois, 60606-3997, (312) 793-8550

2017 MOTOR VEHICLE THEFT PREVENTION TRUST FUND INSURER WORKSHEET

INSURER WORKSHEET INSTRUCTIONS
 
1.     Payment for calendar year 2016 must be received by the Council by April 1, 2017.
 
2.     Please fill out the worksheet below. You must complete and submit one worksheet for each insurance agency you represent. 
 
3.     The following definitions should be used to complete the worksheet:
 
TOTAL EARNED CAR YEARS - The term "earned car year" means the proportion of a calendar year during which a motor vehicle can be identified as being insured for physical damage insurance coverage.  The term "total earned car years" is the sum of an insurer's earned car years of exposure for the calendar year, rounded to the nearest whole dollar.
 
EXAMPLES - For purposes of calculating the amount to be remitted to the Council by insurers, a motor vehicle insured for physical damage insurance coverage for three (3) months during a calendar year would constitute 0.25 total earned car years and would be assessed $.25 ($1.00 x 0.25); four (4) motor vehicles insured for six months each during the calendar year would constitute the sum of two (2) total earned car years and would be assessed a fee of $2.00
 
PHYSICAL DAMAGE INSURANCE COVERAGE - The term "physical damage insurance coverage" means motor vehicle insurance provided for theft and/or comprehensive coverage.
 
PRIVATE PASSENGER MOTOR VEHICLE - The term "private passenger motor vehicle" means any private passenger car, station wagon, jeep, or pickup truck with a load capacity of 1,500 pounds or less not used principally for business purposes, and small farm trucks.  This term includes, but is not limited to jeeps, pickup trucks, mini-vans, vans, and conversion vans.  The term excludes uninsured motor vehicles, motorcycles, motor homes, motor scooters, golf carts, off-road recreational vehicles, and all-terrain vehicles, off-highway motorcycles, street cars, and special mobile equipment as defined under Chapter 1 of the Illinois Vehicle Code (625 ILCS 5/1-101 et seq.).
 
FEIN NUMBER - The nine character alphanumeric field reflecting the insurer's Federal Taxpayer Identification Number assigned by the Internal Revenue Service.  
 
4.     If an insurer owes no Trust Funds pursuant to the Act, the worksheet must reflect a zero (0) "Total Earned Car Years" and "Total Fee". ONLINE WORKSHEET MUST BE COMPLETED EVEN IF NO FEE IS DUE. 
 
5.    If an insurer owes Trust Funds pursuant to the Act, complete and submit the worksheet. Your completed worksheet will be e-mailed to you in PDF format. Please print, sign, and return the worksheet with your remittance. 
 
6.    Remittance must be in the form of a certified or corporate check made payable to:
 
TREASURER, STATE OF ILLINOIS
 
7.    Attach remittance to the printed worksheet and mail it to:
 
ILLINOIS MOTOR VEHICLE THEFT PREVENTION COUNCIL
c/o ILLINOIS CRIMINAL JUSTICE INFORMATION AUTHORITY
300 West Adams Street, Suite 200
CHICAGO, ILLINOIS 60606-3997
 
Attention:  Office of Fiscal Management
 
8.     On or before April 15, 2017, the Council will provide the Illinois Department of Insurance with a report on this annual assessment, including lists of insurers that returned their worksheets by the deadline of April 1, 2017, insurers that submitted late worksheets, insurers that did not return worksheets, and funds contributed.
 
9.     All inquiries should be directed to the Program Director for the Illinois Motor Vehicle Theft Prevention Council at the address indicated (PHONE: 312-793-8550) (FAX: 312-793-8422) (TDD: 312-793-4170) between the hours of 8:30 a.m. and 4:00 p.m.(CDT), Monday through Friday. 

CONTACT INFORMATION OF OFFICIAL COMPLETING WORKSHEET:
Total Earned Car Years Information: Please round to nearest whole dollar using NO periods, commas, or symbols. Example: Total Earned Car Years 125 x $1 = 125
Total Earned Car Years Information: Please round to nearest whole dollar using NO periods, commas, or symbols. Example: Total Earned Car Years 125 x $1 = 125Total Earned Car Yearsx $1.00Total Fees Due
A PDF of your completed worksheet will be emailed to you. If funds are owed, print, sign, and return the worksheet and a certified or corporate check made payable to TREASURER, STATE OF ILLINOIS. Mail to:

ILLINOIS MOTOR VEHICLE THEFT PREVENTION COUNCIL
c/o ILLINOIS CRIMINAL JUSTICE INFORMATION AUTHORITY
300 West Adams Street, Suite 200
CHICAGO, ILLINOIS 60606-3997

ATTN: OFFICE OF FISCAL MANAGEMENT


Worksheet and remittance are due to the Motor Vehicle Theft Prevention Council by April 1, 2017. You must complete and submit one worksheet for each insurance agency you represent.