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Application Requirements


Governmental employers who want to self-insure for workers’ compensation purposes must meet the definition of Section 440.38(6), F.S. Once your organization has determined that it meets the statutory definition, it should proceed with completing the government application form and all of the requirements outlined in governing rules. Please use the forms below when applying to become a governmental self-insured employer.

Rule:

Required Forms and/or Documents:

  • DFS-F2-SI-1G, Application for Governmental Self-Insurance
  • DFS-F2-SI-GEP, Application for Governmental Self-Insurance Estimated Payroll
  • DFS-F2-SI-19, Certification of Servicing for Self-Insurers
  • Copy of Articles of Incorporation, Charters or Bylaws through which the entity is organized or authorized
  • Copies of NCCI Experience Modification Worksheets (current and two preceding years)

Mailing Address:

  • Self-Insurance Unit
    Division of Workers’ Compensation
    Florida Department of Financial Services
    200 East Gaines Street
    Tallahassee, Florida 32399

Email:

Contact Us:

  • Dwayne Manning (850) 413-1784