Filing Automobile and General Liability Insurance Claims

Claim Forms:  Complete the claim form in as much detail as possible. Be sure to sign and date in the space provided at the bottom of the form. Include all information relative to the claim, in particular, police or accident reports, photographs, witness statements, receipts, quotes, etc. Please forward completed form via email, fax, or U.S. mail. Please contact Risk Management with any questions

The Automobile Accident Report is for incidents resulting in injury or property damage to others involving state vehicles or employees on official business. 

Automobile Accident Report Adobe .pdf document icon

The General Liability Loss Report is for reporting incidents involving injury or property damage, on university property or involving university employees.

General Liability Loss Report Adobe .pdf document icon

The Lien Disclosure Statement is required for those persons filing a claim or lawsuit against the State of Florida, its agencies or Universities, to provide specific information prior to 1) settlement of a claim, 2) close of litigation discovery, or 3) commencement of trial, whichever is sooner.

Lien Disclosure Statement Adobe .pdf document icon

 

EHSA Log-In
Risk Management
Contacts

Main Phone: 407-823-6300
Fax: 407-823-0146

P.O. Box 163500
3540 Perseus Loop, Bldg. 16A Facilities and Safety
Orlando, FL 32816-3500

Blake LovvornAssistant Director
407-823-0206