Safety & Loss Prevention

Certificate of Coverage

Form 7.D.15

CERTIFICATE OF COVERAGE
UNIVERSITY OF WISCONSIN SYSTEM

This is to certify that the authorized operator of this State-owned vehicle is protected by the State of Wisconsin Self-Funded Liability and Property Programs. Sections 20.865 (1) (f) and (fm), Wisconsin Statutes, provide funds to pay liability and property claims. In addition, section 895.46 of the Wisconsin Statutes provides that the State will defend and pay judgments taken against State officers, employees and agents for acts carried out while the officers or employees were acting within the scope of their employment.

This certificate is evidence of protection for applicable liability claims brought against the State, its officers and employees, and for damage to property for which officers and employees of the State may be responsible as indemnitors. This certificate is not a policy or binder of insurance and does not in any way alter, amend or extend the coverage afforded by any Statute referenced herein. The coverage is subject to all terms and conditions of the statutory authority.

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STATE AGENCY:

Board of Regents to the
University of Wisconsin System
780 Regent Street, Suite 145
Madison, WI 53715

INSTITUTION NAME:                                                
DATE ISSUED:                                                



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This certificate of coverage must be retained in the glove compartment of all vehicles owned by the University of Wisconsin or owned by the State of Wisconsin and used by the University. This certificate may be used by the vehicle driver to provide proof of financial protection in the event of an accident. Any questions regarding the use of this certificate must be directed to the Institution's Office of Risk Management or to UW System Risk Management.

SIGNED: ______________________________

Institutional Risk Manager

Phone-( )______________

______________________________

UW System Risk Manager

Phone-(608)890-4792