Notice of Business License Insurance and Bond Modification

Certain Basic Business licensees are required to maintain the insurance and bond coverage as specified in the D.C. Municipal Regulations. Additionally, the Department of Licensing and Consumer Protection must be notified of any cancellation and/or update to any insurance and bonding policies associated with an existing Basic Business License. You may use this form to notify the Department of any changes to insurance and/or bond policies.

Learn more about insurance and bonding requirements:

Certificate of Liability Insurance
Surety Bond

Name of Insured

Insured's Basic Business License Number

Notice Type

Bond Cancellation

Bond Update

Insurance Policy Cancellation

Insurance Policy Update

Reason for Bond Cancellation

Reason for Bond Update

Describe OTHER Reason for Bond Cancellation

Describe OTHER Reason for Bond Update

Upload Bond Cancellation

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Upload Bond Update

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Reason for Insurance Policy Cancellation

Reason for Insurance Policy Update

Describe OTHER Reason for Insurance Policy Cancellation

Describe OTHER Reason for Insurance Policy Update

Upload Insurance Policy Cancellation

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Upload File(s) Insurance Policy Update

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Insurance/Bond Company Information

Name of Insurance/Bonding Company

Title

Phone Number

Email Address

I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.

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Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

DC INSPECTOR GENERAL HOTLINE: If you are aware of corruption, fraud, waste, abuse, or mismanagement involving any DC Government agency, official or program, contact the Office of the Inspector General (OIG) at 202-727-0267 or 1-800 521-1639 (toll free). All reports are confidential and you may remain anonymous by law. Government employees are protected from reprisals or retaliation by their employers for reporting to the OIG. The information you provide may result in an investigation leading to administrative action, civil penalties, or criminal prosecution in appropriate cases.