Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69H - Division of Risk Management › Chapter 69H-2 - STATE RISK MANAGEMENT TRUST FUND, STATE CASUALTY CLAIMS › Section 69H-2.004 - Certificate of Coverage

Current through Reg. 50, No. 138; July 16, 2024
(1) The Department
				shall adopt and use a Certificate of Coverage form indicating the insured
				agency and the coverage provided by the Fund.
(2) Form Dfs-d0-867, "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
http://www.flrules.org/Gateway/reference.asp?No=Ref-15485
.
(3) Form Dfs-d0-863, "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
http://www.flrules.org/Gateway/reference.asp?No=Ref-15482
.
(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
http://www.flrules.org/Gateway/reference.asp?No=Ref-15483
.
(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.
(6) Form Dfs-d0-865, "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
				42 U.S.C.
				1983 or similar federal statutes to the
				agency named on the certificate. A copy of the form is available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15494
.
(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.
(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
				 112.1816(2),
				F.S. A copy of the form is available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15492
.
(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/
.
Rulemaking Authority
					 284.311,
					 284.39 FS. Law Implemented
					 284.30,
					 284.31
					 FS.
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.