1. A. Self-insurance applicant qualification. A person or entity may apply for self-insurance under this Section if the applicant:

   1. 1. Owns the minimum number of vehicles prescribed under A.R.S. § 28-4007(A) with current Arizona registration;
   2. 2. Demonstrates minimum assets of $1 million on documentation required under subsections (C) and (D);
   3. 3. Meets any additional financial responsibility requirements under A.R.S. § 28-4033(A), according to the insured vehicle’s weight and/or intended use; and
   4. 4. Provides a business office contact for the company with a current phone number and mailing information.

2. B. A self-insurance applicant shall provide, on a self-insurance application form provided by the Department, the following information:

   1. 1. Applicant’s name;
   2. 2. Business name, if applicable;
   3. 3. Mailing address, city, state, and ZIP code;

   4. 4. A selection of coverage type:

      1. a. Public liability only; or
      2. b. Public liability and property damage;
   5. 5. Number of vehicles in the applicant’s fleet;
   6. 6. A selection list that describes the nature of the applicant’s business;
   7. 7. A description of any hazardous materials transported by type, class, and weight;
   8. 8. A report of all accidents in the prior 39-month period before the application date;
   9. 9. The applicant’s signature and official business title to certify that all information is true and correct; and
   10. 10. Acknowledgment by a notary public or by the signature of an authorized Department agent.

3. C. Supplementary documentation. In addition to a completed self-insurance application form, the applicant shall submit a profit and loss statement certified by a Certified Public Accountant for the 12-month period before the application date. The profit and loss statement shall include one of the following:

   1. 1. A balance sheet; or
   2. 2. An annual financial report.
4. D. On approval of an application, the Department shall issue a certificate of self-insurance that is continuously valid, but shall require the self-insurer to submit a 12-month update of supplementary documentation prescribed under subsection (C) on or before July 1 of each successive year.

5. E. An initial self-insurance applicant or a self-insurer making an annual update shall submit documentation required under subsections (B) through (D) to the following address:

   Motor Vehicle Division

   Financial Responsibility Unit

   P.O. Box 2100, Mail Drop 535M

   Phoenix, AZ 85001-2100

6. F. A self-insurer shall keep a copy of the self-insurance certificate in each covered vehicle at all times.
7. G. A self-insurer shall submit periodic, written notification updates to the Department of vehicles added or removed from self-insurance coverage. The written notification shall include the vehicle identification number of each vehicle.
8. H. A self-insurer that terminates self-insurance shall provide new evidence of financial responsibility as required under A.R.S. § 28-4135 for each vehicle previously covered under a self-insurance certificate.

9. I. In addition to the reasonable grounds prescribed under A.R.S. § 28-4007(C), the Department may cancel a self-insurance certificate under the following circumstances:

   1. 1. A self-insurer fails to comply with provisions of the Department’s annual update requirement under subsection (D), or
   2. 2. A self-insurer no longer owns the covered business or fleet.
10. J. For the purpose of A.R.S. § 28-4007(C) and this Section, the Department shall conduct a self-insurance cancellation hearing according to the provisions prescribed under 17 A.A.C. 1, Article 5.

Historical Note

New Section made by final rulemaking at 13 A.A.R. 858, effective March 6, 2007 (Supp. 07-1). Section amended by final expedited rulemaking at 24 A.A.R. 279, effective January 12, 2018 (Supp. 18-1).