Insurance Application and Board Documents

Thank you for your interest in participating in the CharterSAFE Self-Insurance and Risk Management Services Program. The first required step to obtaining a Premium Indication or proposal is to complete and submit the CharterSAFE application, along with all the supporting documents. There are required CharterSAFE board documents that will need to be reviewed, completed, and submited by your school board.
The CharterSAFE application and each required board document is listed below for you to download and complete.
DEADLINE: All documents including the proposal must be fully completed and received by the 1st of the prior month to receive coverage starting at the new calendar quarter. For example, to start coverage January 1, all documents must be completed and received by December 1.

TIP: Start the Application process and the Board Document Approvals in parallel. Passing the board resolutions will NOT obligate you to participate in the insurance program. However, not obtaining the proper board resolutions will prevent you from participating in the self-insured program.
If you have any questions or need help, please contact:

  Jennifer Rubin
Managing Director, 
School Insurance
Main: 888.901.0004
Direct: 805.285.5258
Fax: 530.236.9569


  Thuy Wong
Vice President,
Operations and Insurance
Main: 888.901.0004
Direct: 949.488.2340
Fax: 530.236.9569


  1   Insurance Application       
CharterSAFE New Member Application
CharterSAFE New Member Exposure Spreadsheet
CharterSAFE New Member Board and Employment Liability Application

  2    School Board Overview and Master School Board Resolution -
 authorizing school principal to complete other resolutions
    CCSJPA Board Resolution 
  3    California Charter Joint Powers Authority Agreement     CCSJPA Bylaws
CCSJPA Agreement 
   School Excess Liability Fund Board Resolution      
   State Department of Industrial Relations Board Application and Resolution to become self-insured     WC Application and Resolution to Self-Insure