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Insurance Requirements and Contracts Section
Self-Insurance Letter (PDF)

Sample Certificate of Insurance

Please submit documents to:
Risk Management Division
Insurance Requirements & Contracts Section
115 South Andrews Ave, #210
Ft Lauderdale, FL 33301
Phone: 954-357-7210
Fax: 954-357-5456

You may email the documents to the appropriate email address listed below:

Liability Section

Broward County General Public Notice of Injury or Property Damage Form (PDF)

Safety and Occupational Health Section

Request for Criminal Background Information (PDF)

*Note - The above form must be completed for employment applications and Volunteer / Community Service Worker applications.

Workers’ Compensation Section

Instructions for completing the State DWC-1 First Report of Injury or Illness Form (PDF)
State DWC 1 First Report of Injury or Illness Form (keyboard enterable PDF)

Required Plug-ins: PDF icon  Adobe® Reader®​​​​​​​​​​