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Agency Info
Forms & Manuals

 

Phoenix
100 N. 15th Avenue
Suite 301
Phoenix, Arizona 85007
Phone: (602) 542-2182

Tucson
400 W. Congress #250
Tucson, Arizona, 85701
Phone (520) 628-6700

The major responsibilities within the Insurance Section:

Purchasing Excess and Catastrophe insurance to supplement funded self-insurance;

Agency Support / Customer Service:

  • We assist your State agency with the process of approving Certificates of Insurance when your agency needs to show evidence of State coverage to an outside entity (such as a landlord);

  • Insurance Analysts will answer questions from state agencies on Who Is Covered by the self-insurance law (ARS 41-621), and Who Is Not Covered.

  • Insurance Analysts will advise your agency of the DOA rules that may affect Agreements of Indemnity that your agency may be asked to sign.

  • Insurance Analyst will advise on volunteer coverage questions. See the Volunteer Registration Form for coverage and sample of form for agency use.

If you are: Then link with:
   
A Procurement Officer: Procurement Officer Insurance Modules
   
Traveling outside the USA:

Overview - Mexico and other Foreign Travel

  Bulletins - War
  Bulletins - Rentals Vehicles - Collision
 

Mexico

  Students, Chaperones & Volunteers
  Travel Warnings
  Travel Assistance
   
Requesting evidence of state coverage: Requesting Certificate Of Insurance
   
Volunteering to the State: Risk Management has purchased a policy specifically for Volunteers working for and on behalf of the State of Arizona and Students traveling to and from an approved function of the school in an authorized mode of transportation. Should you have any questions on this program call Kristine Rowen at (602)542-1445.
  Volunteer Registration Form
 

Summary

  Policy
  Claims Form
   
Providing care in a program for Foster Parents, Independent Living, Respite Sitters, or Developmental Disabilities:

Provider Indemnity Program

   
Working with the Risk Management Biennial Exposure Survey: Risk Exposure Survey
   
Flying on behalf of your Agency Pilot Applications

 

Insurance Forms -

 Agency Guide for Submitting Contract Exceptions

 Analyst Assignment List

Independent Contractor Agreement

Insurance and Indemnity Modules

Assistance - Foreign Travel

Certificate of Insurance (ACORD form tutorial-coverage from Vendor)

Certificates of Insurance (Request from Agency to show ADOA coverage)

Indemnification Language - Commentary

Arizona Workers' Compensation Law - Notice to Employees (Bilingual)

Pilot Applications

Provider Indemnity Program (PIP) Brochure

Self-Insured Contractor

Self-Insured Vendor

Sole Proprietor Waiver

Statutory Exclusions of Coverages

Volunteer Registration Form