Insurance

MLCC Insurance Forms
Use the forms below when submitting proof of insurance to the Michigan Liquor Control Commission

Retail licensing Proof of Financial Responsibility (liquor liability insurance) form
(Required by MCL 436.1803)

Proof of Financial Responsibility (LC-95)
 

Manufacturer & Wholesaler Surety Bond form
(Required by MCL 436.1801)

Surety Bond (LC-MW-816)
 

Effective July 1, 2017, the MLCC will securely dispose of any insurance documents it receives from insurance companies that are mailed to the MLCC, including Acord documents.  The MLCC will not notify the insurance company that mailed the documents of this, nor will it notify the insured applicant or licensee.  It is the responsibility of the applicant or licensee to ensure that the required proof of liquor liability insurance has been received by the MLCC using the Commission-approved Proof of Financial Responsibility Form (Form LC-95) pursuant to administrative rule R 436.2005. Acord documents are not acceptable as a substitute for the LC-95 form and will be disposed of securely whether submitted by mail, fax, or email.  Applicants, licensees, or insurance companies may submit the LC-95 form in electronic format to MLCCInsurance@michigan.gov.

If you received an Emergency Suspension Order due to no Proof of Financial Responsibility, but your business is now closed, please complete the escrow request form and return with your original license and permit document: Request to Place License in Escrow (LCC-108).

Use this link to find a new insurance agency eligible to write commercial insurance in Michigan: DIFS Search Criteria for Insurance Agencies

Use this link to find a specific insurance carrier eligible to write commercial insurance in Michigan: DIFS Search Criteria for Insurance Entities

Use this link to verify license information or to see if we have received your newest Proof of Financial Responsibility for an active or escrowed license: Active/Escrowed License Search

Please use this link to verify licensing information for an applicant (license not yet issued): Application Status Search