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What should I do when someone wants to file a Liability claim against my district?

The CAPRI Claims Manual provides detailed instructions on how to handle a Liability claim made against the district. Exhibit F in the claims manual should be provided to the claimant to assist them if filing a formal claim. Please note that all claims received by the district should immediately be forwarded to:

Matthew Duarte
Executive Director
1075 Creekside Ridge Drive, Suite 240
Roseville, CA 95677
(916) 722-5550
Fax: (916) 722-5715

How do I file a Workers’ Compensation claim?

Within 24 hours of an employee being injured on the job, the district must provide the employee with a DWC-1 notice, the district must complete the Employer portion of DWC-1, Form 5020, and the Supervisor’s Report of Injury.

Fax or email above forms to:

Sally Town
Workers’ Compensation Claims Examiner
Phone: 916.960.0969

How do I request a Certificate of Coverage and an Attachment to Coverage?

Contact Denise Flores to request a Certificate of Coverage or an Attachment to Coverage.

Denise Flores

What should I do if my district sustains a Property Loss?

The district must notify CAPRI within 72 hours following your discovery of the loss. The district must also complete the Property Loss Notice Form (Exhibit S in the CAPRI Claims manual) and forward it to the CAPRI office. If the loss was the result of a criminal act (theft, vandalism, arson, etc.) or vehicle accident, provide CAPRI with a copy of the police report. After the damage has been repaired, organize and forward the paid invoices to the CAPRI office for payment.

I have a facility renter who cannot provide the district with the appropriate insurance limits. How can they obtain the coverage?

CAPRI’s broker, Alliant Insurance Services, has made special event coverage available to individuals or businesses renting districts facilities.

Eve Wildhagen
Account Manager

Can I send my safety committee minutes to CAPRI via e-mail?

Yes. Direct your safety committee minutes to:
Kirk Andre
Safety Analyst

My District has acquired a new vehicle. How do I obtain a new insurance card?

Please fill out the CAPRI Vehicle Add/Delete Form and return to:

Monica Breck


Vehicle Add Delete Form