Statement of Self Insurance

If you are required to provide a Statement of Self Insurance to a vendor, contractor, or other entity for any reason, please submit an Assistance Request Form (PDF) with the following information:

  • Statement Holder (name, address)
  • Start/End Date of Contract/Agreement/Activity
  • Time(s)
  • Location(s)
  • Description of activities
  • For equipment leases: Model Number, Serial Number, Description and Dollar value
  • Attach copy of Contract/Agreement/Application Form/Permit/License/Other

Please allow at least 10 days for processing.


The State Risk Management and Insurance Administration program (Risk Management Program) provides both liability and physical damage coverage (comprehensive/collision and fire/theft) for University-owned and leased vehicles.

Automobiles covered by the Risk Management Program

  • University-owned vehicles
  • Leased, hired, rented, and other non-owned automobiles when authorized by the University and operated under the name of the University.
  • Employee-owned automobiles while used in the course and scope of employment and in the name of the State will have excess liability over the employee’s own personal automobile insurance policy. Physical damage to employee’s own vehicle is not covered.

Authorized drivers

  • University of Hawaiʻi employees, officers, Board members
  • Official volunteers
  • Student employee drivers
  • Any other authorized individuals (except independent contractors) licensed to operate an automobile covered under this policy

Scope of Liability Coverage

  • No-fault coverage as required by State law for bodily injury and property damage resulting from accidents involving autos covered under the Program.
  • Coverage for physical damage to University-owned automobiles from collision, fire, theft or comprehensive loss is not provided unless the auto has been specifically designated for coverage and approved by UH Risk Management and RMO-DAGS.
  • Claim payments will not exceed the actual cash value (ACV) of the covered vehicle. ACV is obtained by averaging the blue book value and market sales on comparable vehicles.
  • Medical and income benefits will be provided under the State Workers’ Compensation Law for injuries sustained by State employees in autos covered under the Program from accidents arising out of and in the course of their employment.

Automobile Rentals

  • In-State: University employees should not purchase a Loss Deductible Waiver (also referred to as “Collision Deductible Waiver”) or Personal Accident Insurance.
  • Out-of-State: It is advisable to purchase Loss Deductible Waiver (also referred to as “Collision Deductible Waiver”).
  • Foreign Country: It is highly advisable to purchase both Loss Deductible Waiver (also referred to as “Collision Deductible Waiver”) insurance AND liability insurance.


The State Risk Management and Insurance Administration program (Risk Management Program) provides insurance coverage for University-owned property, and property in the care, custody and control of UH.

Property Covered by the Risk Management Program

  • Buildings
  • Contents
  • Equipment


  • Intentional, fraudulent or dishonest acts
  • Ordinary wear and tear
  • Faulty design, material or workmanship
  • Watercraft over 30 feet only while waterborne
  • Aircraft
  • Growing crops, standing timer used for industrial purposes, live animals not used for research
  • Export and import shipments in ocean transit
  • Infrastructure (e.g. lights, electricity, sewage)
  • Fences, trees

Conditions for Coverage

  • Items must be listed on the UH inventory system, or supported by accounting documents
  • Buildings must be on State of Hawaiʻi Inventory (to add a building to inventory, submit a “Data Requirements—Property” (DOC) form to the Office of Risk Management).
  • Item must be not more than 7 years old or scheduled for replacement

Purchasing Insurance

Vice Presidents and Chancellors are responsible for determining the nature and extent of insurance coverage necessary for their respective programs. The Office of Risk Management is responsible for processing the purchase of all insurance policies for compliance with University purchasing requirements. All insurance purchases should be routed to the Office of Risk Management via KFS.

Third Party Minimum Insurance Requirements

The Office of Risk Management recommends that third parties who will be performing work or providing services to the University; or using University facilities be required to carry certain types of insurance coverage at specified minimum limits:

  • Commercial General Liability (bodily injury and property damage; personal and advertising injury; contractual liability, products and completed operations): $1 million combined single limit per occurrence, $2 million aggregate
  • Worker’s Compensation: contractors and suppliers should carry limits complying with Hawaiʻi law
  • Automobile Liability (if the outside party uses a vehicle that is integral to work performed or will be operating a vehicle on UH property): $1 million combined single limit (SCL) each occurrence, to include either “ANY AUTO” or “SCHEDULED, HIRED, OWNED, NON-OWNED AUTOS”
  • Professional Liability (when a supplier has a professional designation or license and/or is providing professional services): $1 million per claim, $2 million annual aggregate (will vary by project)
  • The type and minimum amounts of insurance coverage required may vary based on the type of work performed, service provided or activity. The University reserves the right to require higher limits or additional types of insurance from a contractor or vendor for a particular project or event.

Certificate of Insurance

A Certificate of Insurance is a document that provides information about insurance policies. Generally speaking, certificates list one or more lines of insurance, the limits associated with these coverages, and the insurer providing coverage.

  • Third parties who are required to carry insurance should provide a duly executed Certificate of Insurance evidencing the requisite types and limits of insurance no less than one week prior to the date of event/contract/service.
  • Each certificate shall specify that the policy cannot be cancelled before the expiration date thereof and notice will be delivered in accordance with the policy provisions, that the University of Hawaiʻi and State of Hawaiʻi are named as additional insureds, that the insurer waives any subrogation rights against the University of Hawaiʻi and State of Hawaiʻi, and that any insurance maintained by the University of Hawaiʻi and/or the State of Hawaiʻi will apply in excess of, and not contribute with, insurance provided by this policy.
  • Certificate of Insurance Guide.
Last modified: October 17, 2016
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