Section 69H-2.004 - Certificate of Coverage(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/.Fla. Admin. Code Ann. R. 69H-2.004
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, Amended by Florida Register Volume 49, Number 129, July 5, 2023 effective 7/18/2023.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.