Filed with the Virginia Department of Motor Vehicles (DMV).
This is to certify that the (Company) of
has issued to
of
a policy or policies of insurance effective from 12:01 A.M. standard time at the
address of the insured stated in said policy or policies and continuing until cancelled as provided herein, which
has or have been amended to provide TNC broker insurance as defined at Va. Code § 46.2-2000 and
covering the obligations imposed upon such TNC broker under Va. Code § 46.2-2099.19:1.
Whenever requested, Company agrees to furnish DMV a duplicate original of said policy or policies
and all endorsements thereon.
The insurance policy or policies described herein remains effective absent written notification to DMV.
Cancellation or non-renewal may be effected by Company or the insured giving thirty days' notice in writing to
DMV, commencing from the date notice is actually received in the office of DMV.
Countersigned at:
this day of , 20
Insurance Company File No.
VIRGINIA TNC BROKER
INSURANCE CERTIFICATE
INSURANCE COMPANY NAME
INSURANCE COMPANY ADDRESS
NAME OF TNC BROKER TNC BROKER ADDRESS
EFFECTIVE DATE
MCS 310 (07-01-2017)
CITY, STATE, ZIP,CODE
STREET ADDRESS
AUTHORIZED COMPANY REPRESENTATIVE
POLICY NUMBER
