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Florida Administrative Code (Last Updated: April 18, 2024) |
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69. Department of Financial Services |
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69H. Division of Risk Management |
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69H-2. State Risk Management Trust Fund, State Casualty Claims |
1(1) The Department shall adopt and use a Certificate of Coverage form indicating the insured agency and the coverage provided by the Fund.
24(2) Form 26Dfs-d270-867, “State Employee Workers’ Compensation and Employer’s Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide employee workers’ compensation and employer’s liability coverage to the agency named on the certificate. A copy of the form is available at 72http://www.flrules.org/Gateway/reference.asp?No=Ref-1548574.
75(3) Form 77Dfs-d780-863, “General Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide general liability insurance coverage to the agency named on the certificate. A copy of the form is available at 115http://www.flrules.org/Gateway/reference.asp?No=Ref-15482117.
118(4) Form DFS-D0-864, “Automobile Liability Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide fleet automobile liability coverage to the agency named on the certificate. A copy of the form is available at 157http://www.flrules.org/Gateway/reference.asp?No=Ref-15483159.
160(5) Form DFS-D0-864A, “State Risk Management Trust Fund Addendum to Automobile Liability Certificate of Coverage for Off-Duty Law Enforcement Vehicle Property Damage,” (Rev. 11/05), incorporated herein by reference, will be used to provide an addendum to automobile liability coverage to the agency named on the certificate.
207(6) Form 209Dfs-d2100-865, “Federal Civil Rights Liability and Employment Discrimination Certificate of Coverage,” (Effective 07/23), incorporated herein by reference, will be used to provide coverage for federal civil rights actions under 24042 U.S.C. 1983 243or similar federal statutes to the agency named on the certificate. A copy of the form is available at 262http://www.flrules.org/Gateway/reference.asp?No=Ref-15494264.
265(7) Form DFS-D0-862, “Court Awarded Attorney Fees Certificate of Coverage,” (Rev. 11/05), incorporated herein by reference, will be used to provide coverage for court awarded attorney’s fees in other proceedings against the agency named on the certificate.
303(8) Form DFS-D0-1994, Firefighter Cancer Benefits Certificate of Coverage, (Effective 07/23), incorporated herein by reference, will be used to provide coverage for firefighter cancer benefits payable under Section 331112.1816(2), F.S. 333A copy of the form is available at 341http://www.flrules.org/Gateway/reference.asp?No=Ref-15492343.
344(9) Copies of these forms are available from the Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, FL 32399-0337, or at https://myfloridacfo.com/Division/Risk/.
371Rulemaking Authority 373284.311, 374284.39 FS. 376Law Implemented 378284.30, 379284.31 FS. 381History–New 7-29-72, Formerly 4-30.05, 4-30.005, Amended 1-7-92, 6-28-01, Formerly 4H-2.004, Amended 5-4-05, 7-23-06, 7-18-23.
