COMPUTER DATA REQUEST FORM
State of Illinois Seal Mail To:
Public Sale Coordinator
Information Systems Section
Illinois Department of Insurance
320 West Washington Street, Fourth Floor
Springfield, Illinois 62767-0001
The information available from the Illinois Department of Insurance, pursuant to [215 ILCS 5/408.2] is listed below.
For assistance call the Public Sale Coordinator at (217) 524-0605 - TDD (217) 524-4872 or e-mail Suzann.Rhodes@illinois.gov.
See also the Department's Internet Site at http://www.insurance.illinois.gov
Instructions:
  • All sales final. The Department does not have refund authority.
  • This form must be completed entirely before requests can be processed or mailed.
  • Payment must be received before requests can be processed or mailed.
  • The Department of Insurance will supply IBM-compatible high-density diskettes or CD for any data set requested.
  • Customer must specify comma delimited or non-delimited ASCII format.
  • Return completed request form with your check made payable to Director of Insurance/SSRF to above address.
Data Requested:
__ Diskette:
__ CD		 Data Type:
 __ Comma Delimited
 __ Non-Delimited		 Amount Enclosed:
The undersigned hereby agrees that any data received as a result of this request will not be resold, reconveyed or otherwise transferred for cash, merchandise or any consideration or thing of value, to any individual, corporation, association or other third party.
Requestor's Signature:

X
Date Signed: Phone (with Area Code):
Mail Request to: FEIN/SSN:
Street:
City & State: Zip:

PRICE SCHEDULE---Effective June 1, 2009
 
Licensee Data
Business Entity Licenses $600/List/Diskette
Business Entities from Upstate (zips 60000-60844) $300/List/Diskette
Business Entities from Downstate (zips 60845-62999) $300/List/Diskette
Applicants Passing Exams $100/List/Diskette (semi-monthly)
All Producers or Producers with specific authority $600/Diskette/CD, $1000/List
Producers from Upstate (zips 60000-60844) $300/Diskette, $500/List
Producers from Downstate (zips 60845-62999) $300/Diskette, $500/List
Producers from Ten Zip Codes $150/List/Diskette
Premium Finance, Public Adjuster OR Surplus Line Licensees $100/List/Diskette
Third Party Administrators and Third Party Prescription Program licensees/registrants $100/List/Diskette
Complaint Data
Non-Confidential Standard Report (complaints by company, coverages or reasons) $200/Report
Insurer Data
Company Name, Address, Phone and Authority (all companies) $100/List/Diskette, $200 Labels
Company Name, President, Address and Phone (all companies) $100/List/Diskette, $200 Labels
HMO Company Name, Address, Phone and County Service Area $25/List/Diskette
Managed Care Organization Name, Address and Phone $100/List/Diskette
A&H Company FEIN's, Address and Phone $100/List/Diskette
Licensed Insurers and Accredited/Approved Reinsurers (Available only to Companies) $100/List/Diskette
Company Name and Address for Worker's Comp $100/List/Diskette
Homeowner/Residential Fire Policy Counts
Raw Data through 1995 $200/Diskette (quarterly)
Raw Data after 1995 $600/Diskette (only annually)
Zip Code Market Share Report $400/Report
Company Detail Report for Chicago and East St. Louis through 1995
(New, renewal, non-renewal, and cancellation by ZIP)		 $200/Report (quarterly)
Company Detail Report for Chicago and East St. Louis after 1995
(New, renewal, non-renewal, and cancellation by ZIP)		 $600/Report (only annually)

All Sales Are Final - The Department of Insurance Does Not Have Refund Authority.