To be included in the resource center, please submit the following information to Kelly Kruger at:   kelly.kruger@illinois.gov

Producers
Producer Name
Producer Business Address
Producer Business Telephone Address
Producer Birth date*
Producer License Number*
Name of each licensed company for which the producer sells medical professional liability insurance.

(NOTE:  Misrepresentation of any information reported may be a violation of Section 215 ILCS 5/500-70 of the Illinois Insurance code and could result in disciplinary action.)

Companies
Company Name
Company Telephone Number
Hyperlink to Company’s Website (if available)

Base Rate Sample Forms:
     Base Rate & Rating Relativity Factors for Hospitals
     Base Rate & Rating Relativity Factors for Other Health Care Facilities
     Base Rate & Rating Relativity Factors for Physicians including Surgeons and Osteopaths
     Base Rate & Rating Relativity Factors for Other Health Care Professionals, including Dentists