REPORTING LOSSES. The State Report of Incident Form should be used. State agencies must notify the Risk Management & Tort Defense Division of a claim or potential claim as soon as possible, preferably within 5 business days. Claims that involve fatalities or other serious injuries must be reported within 24 hours. Sample forms may be found on the division’s website under ‘Claims.’ You may photocopy them (front and back) as needed. $100,000,000 Combined Property Damage, Breakdown, Business Interruption Extra Expense $25,000,000 Newly Acquired Locations. $10,000,000 Utility Interruption $10,000,000 Consequential Damage / Spoilage $10,000,000 Ammonia Contamination $10,000,000 Water Damage $10,000,000 Demolition/Increased Cost of Construction $ 2,000,000 Electronic Data Processing Media $ 2,000,000 Perishable Goods $ 1,000,000 Ordinance or Law. Varies by object or vessel.
REPORTING LOSSES. The State Report of Incident Form should be used. Claims shall be reported as soon as possible, preferably within 5 business days. Claims not reported within a reasonable period of time may be denied. Attach supporting information, such as:
REPORTING LOSSES. The State Report of Incident Form should be used. State agencies and universities must notify the Risk Management & Tort Defense Division of a claim or potential claim as soon as possible, preferably within 24 hours, but not less than 5 business days. Claims not reported within a reasonable period of time may be denied.
REPORTING LOSSES. The State Report of Incident Form should be used. State agencies and universities must notify the Risk Management & Tort Defense Division of a claim or potential claim as soon as possible, preferably within 5 business days. Claims that involve fatalities or other serious injuries must be reported within 24 hours. Sample forms may be found on the division’s website under ‘Claims.’ You may photocopy them (front and back) as needed. $100,000,000 Breakdown, Extra Expense, etc. $10,000,000 Service Interruption $10,000,000 Consequential Damage $10,000,000 Ammonia Contamination $10,000,000 Hazardous Substances $10,000,000 Electronic Data Processing Media $ 10,000,000 Perishable Goods Varies by object or vessel.
REPORTING LOSSES a. The Local Agency shall report promptly (within 5 days) all instances of lost commodities regardless of the value to the State Agency. Lost commodities are those which, for any reason, cannot be accounted for by appropriate records, or other satisfactory evidence to have been received and properly distributed. Commodities may be lost through, but not limited to, theft, damage, spoilage, infestation in transit or in storage, improper distribution, sale or exchange, diversion to an improper use, failure to deliver, or other similar causes.
b. The Local Agency shall agree to not sell, transfer, barter or offer for sale the items supplied by USDA in exchange for money, property, or services, or otherwise allow the items to re-enter commercial channels.
c. If the Local Agency improperly uses any donated commodity, or causes loss of or damage to a donated commodity, it may be required to pay for the lost commodities at a sum equal to the USDA value established at the time of the loss, or damage to, a donated commodity. The State Agency shall determine the amount of loss. The Local Agency accepts full responsibility for compliance with the provisions of this agreement, including potential liability for any commodities lost through negligence, or any reimbursement reserved for costs inadequately documented. Liability will include the payment of cash for the value of the donated food. If the State Agency determines that overpayment has been made for allowable storage and /or distribution costs, the Local Agency agrees to reimburse the State Agency the sum specified within thirty calendar days from the date of such written notification.
d. If USDA commodities are found to be damaged or out of condition and are declared unfit for human consumption by state or local health officials in a condemnation certificate, the Local Agency shall submit a complete report to the State Agency covering the condition relative to such commodities and must dispose of such commodities in accordance with recommendations and instructions from health officials and/or the State Agency or USDA.
REPORTING LOSSES. The State Report of Incident Form should be used. State agencies must notify the Risk Management & Tort Defense Division of a claim or potential claim as soon as possible, preferably within 5 business days. Fatalities and personal injuries should be reported within 24 hours. Claims that are not reported within a reasonable period of time may be denied. Attach supporting information, such as: Evidence of state ownership or responsibility; Copy of any police or fire department report; Repair estimates, photographs, other data on cost of the damage; Information on any adverse party’s insurance. Sample forms may be found on the division’s website under ‘Claims.’ You may photocopy them (front and back) as needed. Excess limits of $10,000,000 per occurrence above the state’s tort damage caps of $750,000 per claim/$1,500,000 per occurrence, are payable by the state’s excess liability insurance carriers. Physical damage is limited to the lower of the cost to repair or replace the aircraft subject to the values reported by each agency.
REPORTING LOSSES. 1. The State Self-Insurance Claim Report Form should be used for all property losses. It is an all-purpose, self-insured loss and lawsuit report form. Do not use for workers’ compensation and inmate injury claims. The documentation we will require for claims is:
A. Evidence of state ownership or responsibility;
B. Copy of the DMV traffic accident and insurance report, if applicable;
C. Copy of any police or fire department report, if applicable;
D. Repair estimates, photographs, other data on cost of damages;
E. Information on any adverse party’s insurance; and
F. Evidence you complied with any conditions of coverage specified for real or personal property
2. Property losses under the deductible do not need to be reported to Risk Management. We do not handle or adjust these losses.
3. Property losses caused by others that are above the deductible need to be reported to Risk Management as soon as possible and no later than 90 days after you discover it. We will assist your agency in recovering from the other party.
4. All losses to commercially rented vehicles shall be reported. However, losses to commercially rented vehicles under the deductible will be handled by the agency.
REPORTING LOSSES. 1. The State Self-Insurance Claim Report Form should be used for all equipment breakdown losses. It is an all-purpose, self-insured loss and lawsuit report form. Do not use for Workers’ Compensation and Inmate Injury Claims. The documentation we will require for claims is:
A. Evidence of state ownership or responsibility;
B. Copy of the DMV Traffic Accident and Insurance Report, if applicable;
C. Copy of any police or fire department report;
D. Repair estimates, photographs, other data on cost of damages;
E. Information on any adverse party’s insurance; and
F. Evidence you complied with any conditions of payment specified in applicable Equipment Breakdown coverage.
2. Equipment losses under the $25,000 agency deductible do not need to be reported to Risk Management. We do not handle or adjust these losses.
3. Equipment losses caused by others that are above the deductible need to be reported to Risk Management as soon as possible and not later than 90 days after you discover it. We will assist your agency in recovering from the other party.
4. All losses to commercially rented or leased equipment shall be reported. However, losses to commercially rented or leased equipment under the deductible will be handled by the agency.
REPORTING LOSSES. 1. The State Self-Insurance Claim Report Form should be used for all property losses. It is an all-purpose, self-insured loss and lawsuit report form. Do not use for Workers’ Compensation and Inmate Injury Claims. Attach supporting documentation, such as:
A. Evidence of state ownership;
B. A copy of any police or fire department report;
C. Information on any adverse party’s insurance; and
D. Evidence you complied with any conditions of payment specified in the applicable Money and Securities coverage Section.
2. Property losses under the deductible do not need to be reported to us. We do not handle or adjust these losses.
3. Property losses caused by others that are above the deductible need to be reported to Risk Management as soon as possible and no later than 90 days after you discover it. We will assist your agency in recovering from the other party.
REPORTING LOSSES. 1. The State Self-Insurance Claim Report Form should be used for all personal property/ Exceptional Items losses. It is an all-purpose, self-insured loss and lawsuit report form. Do not use for Workers’ Compensation and Inmate Injury Claims. Attach supporting information, such as:
A. Evidence of state ownership or responsibility;
B. Copy of the DMV Traffic Accident and Insurance Report, if applicable;
C. Copy of any police or fire department report;
D. Repair estimates, photographs, other data on cost of damages;
E. Information on any adverse party’s insurance; and
F. Evidence you complied with the conditions of payment specified in this coverage Section for Exceptional Items
2. Exceptional Items losses under the deductible do not need to be reported to Risk Management. We do not handle or adjust these losses.
3. Exceptional Items losses caused by others that are above the deductible need to be reported to Risk Management as soon as possible and not later than 90 days after you discover it. We will assist your agency in recovering from the other party.
