(As Evidence of the Law Firm's Minimum Insurance and/or Proof of Financial Responsibility
In Compliance with Supreme Court Rule 722)
I, ____
_______________________________________ (attorney name), certify, pursuant to §1-109 of the Illinois
Code of Civil Procedure,
that I am an authorized (shareholder
, member or partner) of the law firm
________________________________________ (law firm name), a (corporation, association, company or
); and that this law firm maintains the minimum insurance as required by Supreme Court Rule
722(b)(1), and/or the funds required by Rule 722(b)(3).
nder penalties as provided by law pursuant to § 1-109 of the Code of Civil Procedure, the
undersigned certifies that the statements set forth in this instrument are true and correct, except
as to matters therein stated to be on information and belief and as to such matters the
undersigned certifies as aforesaid that he verily believes the same to be true.
_________________________________ (signature)
_________________________________ (date)
735 ILCS 5/1-109.