Education Provider Change of Address (LIC 446-42)

​​​​​​​​​​​​​​State of California Department of Insurance

Education Provider Change of Address

Department of Insurance
Curriculum and Officer Review Bureau - Education Unit
300 Capitol Mall
Sacramento, CA 95814-4309
Information: (916) 492-3064
www.insurance.ca.gov

LIC 446-42 (Rev. 1/2023)

I am preparing this form as:

Education Provider Change of Address (LIC 446-42)

Mailing

Street address or P.O. Box

Business

P.O. Box is not acceptable

Residence, if sole proprietor

P.O. Box is not acceptable

Record Storage

P.O. Box is not acceptable

Prelicensing and Continuing Education Provider Stipulation to Maintain Records Outside of California (LIC 446-32)

APPLICATION

The undersigned, as provider director of a prelicensing or continuing educaiton provider duly authorized by the California Department of Insurance, has requested the Commissioner's authorization to maintain provider records at a location outside of California.

REFERENCE

California Insurance Code, Section 1749.7. Adminstration: rules and regulations.

The commissioner may, pursuant to Chapter 3.5 (commencing with Section 11340) or Part 1 of Division 3 of Title 2 of the Government Code, adopt reasonable rules and regulations necessary for the convenient adminstration of this article.

California Code of Regulations, Title 10, Chapter 5, Section 2188.4. Maintenance of records.

(e) Provider records are to be maintained for a period of five (5) years and must be made available to the Insurance Commissioner for inspection and copying immediately upon request. All records of providers with an office in this state, or which are otherwise doing business in this State, shall be maintained at a location within the State, unless Form 446-32 Prelicensing and Continuing Education Provider Stipulation to Maintain Records Outside of California (Rev. 10/11) as set forth in section 2188.50 herein, is submitted by the provider director. Failure to comply with this subdivision shall be grounds for rescission of the provider's certification.

STIPULATION

In consideration of the Commissioner's granting of authorization to maintain the records described in California Code of Regulations, Section 2188.4, at a location outside of California, the undersigned provider director, on behalf of the duly authorized education provider, agrees to reimburse the California Department of Insurance for the expense of travel for the Department of Insurance shall constitute grounds for automatic termination of the Commissioner's authorization to maintain records outside of the state, and may also be considered in any subsequent hearing on the rescission of provider status. This agreement will remain in force concurrent with the provider's certificaiton period.

Prelicensing/Continuing Education Program Out-of-State Provider Jurisdiction Agreement (LIC 446-40)

On behalf of the above named provider, I stipulate and agree:

(a) That in any action or special proceeding brought against the provider in the State of California, any document or process may be served on the Commissioner with the same effect as though served upon the provider, and such service will give jurisdiction over the provider to the same extent as if the provider were a resident of the State of California.

(b) That any action or special proceeding brought by the provider against the Insurance Commissioner of the State of California shall be brought in the County of Los Angeles, County of Sacramento or the City of and County of San Francisco.

(c) That the provider will appear at the Office of the Insurance Commissioner in the County of Los Angeles, County of Sacramento or City or County of San Francisco at any time, pursuant to notice of hearing, order to show cause, or subpoena issued by the Commissioner, if such document is deposited in the United States mail, certified and postage prepaid, in a cover addressed to the provider at the last address filed by it with the Commissioner, such deposit in mail being 31 or more days before the date specified in such document for such appearance, and that in the event of failure so to appear the provider hereby consents to rescission or denial of provider certification by the Commissioner.

Provider Director Signature