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This claim category applies to State agencies that suffer damage to any State property, building or asset, due to the negligent and/or intentional acts of third parties (individuals, companies and government-public entities).
Type of Subrogation Claim Action:
Please check all that apply:

1. Damage to State-owned vehicle or motorized equipment (includes State Agency leased and rental Vehicles)
2. Damage to State Agency Office Contents or Equipment
3. Damage to State-owned or Leased facility or building structure
4. Damage to State Highway/Roadway System
5. Damage to Computer Software or Systems
6. Other (Please specify)

Procedural Notice for Subrogation Claim Against 3rd Party for Damage to State Assets

State departments and agencies that suffer damage due to the negligent and/or intentional acts of third parties must use and submit this form as soon as conveniently possible. The Division of Risk Management will pursue and file civil claims against individuals, companies, businesses, or public governmental entities that cause damage to State property.
Please do not file this subrogation claim form if any of the circumstances listed below exist. If your incident involves one or both of the scenarios below, please use the form entitled “Claim for Damages to State Property”.

1. Damage to State Property (building/office contents, etc.) where there is no indication that a third party caused or contributed to the damages in question. ( Please File a Claim for Damages to State Property)
2. Damage to State Property (building/office contents, etc.) caused by the actions or inactions of a State employee, officer, resident, or inmate of a State department, agency, facility, or prison. (Please File a Claim for Damages to State Property).

This claim category applies to damage to State-owned property or facilities that State agencies own, occupy or lease from others, as well as damage to other critical assets.. However, this category does not apply to damage to State Highway Systems or State Vehicles. For Damage to State Highway systems and roadways, see Subrogation Claim category.

Damage and Loss Type Category

Type of Loss
Select all that apply:

Damage-Loss Category
Select all that apply:

Procedural Notice for Claim for Damage to State Property

State departments and agencies must file this form when State-owned or leased property-facilities they occupy suffer damage to the building structure, its contents, and/or results in disruption of their operations. This includes losses to building (structure and contents), land improvements, and equipment such as computer software, boiler, machinery, miscellaneous electrical apparatus, boats and helicopters.

Please note that a separate digital claim form must be filed for each affected location. If multiple buildings were damaged, impacted or affected at a campus-like location, such as prison, park or other similar State site, the agency may include these buildings in one claim form.

DRM must receive the completed form within five (5) days from the date of loss. Under no circumstances should agency personnel dispose of any damaged items without first taking photographs and making an inventory list. Should the damages be caused by the operation of a Non-State vehicle or the clear actions of another individual, entity or vendor/contractor, please also use the Subrogation Claim Form, even if the damage amount is under $100,000.00. Do not file this form if the damages do not exceed $100,000.00 and if there is no potential liable-responsibility third party that caused or contributed to the incident and resulting damage, i.e. third party individual, entity, vendor, contractor, etc.

Steps to take in addition to filing this digital claim form:

1. Theft or Vandalism: Call both the State Police and the local law enforcement authorities to report the loss.
2. Fire: Call the State Fire Marshall at 609-633-6106.
3. Leased Facility - DPMC: If a leased location or building is managed by the Department of the Treasury, Division of Property Management and Construction (DPMC), report the loss by telephone, and in writing to either your Lease Manager or Facility Manager.
4. Mitigating and Documenting Damages: Your agency must take any and all reasonable preventative measures to protect the property, building and contents from further damage or exposure to the elements. Furthermore, you must take pictures of the damaged items and building structure, and inventory them accordingly.

General Exclusions:

1. Settling, cracking or deforming unless collapse of the structure actually occurs.
2. Loss resulting from neglect of the insured to use all reasonable means to save and preserve property when it is in danger of physical damage.
3. Loss resulting from failure to perform proper maintenance on the facility.
4. Losses occurring at locations not reported in LBAM.
5. Mysterious disappearance or shrinkage identified during the annual inventory; depletion, deterioration, corrosion or erosion of material; wear and tear; extreme changes in temperature including freezing, shrinkage or evaporation; moths, vermin or inherent vice (i.e. a latent defect not readily observable or discoverable).
6. Faulty workmanship, materials, construction or design unless an ensuing insured loss occurs. (Please file a Subrogation Claim if the faulty workmanship, materials, construction or design was due to an active, ongoing or recent repair or construction work by an outside vendor or contractor).

This claim category applies to non-collision damage to State Government-Owned Vehicles, which includes State agency leased and rental vehicles.

Note: Incident Categories excluded under this Comprehensive Claim Program & Form are: Striking a Tree, Curb, Pothole, Collision with another Vehicle, hit and run incident, tire blow out, incidents where source of damage is unknown, and other non-comprehensive or collision incidents.

Procedural Notice for Comprehensive Claim for Damage to State Vehicles and Motorized Equipment

State agencies may file this reimbursement form for Comprehensive “non-collision” damage to State Government owned vehicles and motorized equipment only, including State agency leased and rental vehicles.

This Program covers the following: vandalism, flood, fire damage, deer/animal collision, windshield damage by rock debris or object, and for stolen vehicle. State Agencies will be reimbursed for eligible covered losses minus a $250.00 deductible per vehicle. Damages resulting from striking a tree, curb, pothole, another vehicle, hit and run incident, tire blow out, or incidents where source of damage is unknown are not covered.

Please do not submit this form if the damages are $250.00 or less, or if your agency has not filed the required digital RM1- State Vehicle Accident & Incident Form. Please check with your agency’s fleet vehicle coordinator or the State employee assigned to the subject vehicle to see if they filed the digital RM1. Please refer to our website for an overview of the RM1 filing process State of NJ - NJ Treasury - Division of Risk Management.

While you may submit one digital form for multiple State vehicles or motorized equipment, they must all be involved in the same incident or accident, regardless of where the vehicles were located at the time of the natural disaster, i.e. hurricane. For example, if your State agency suffered flood damage to multiple State vehicles at different facilities or location on the same date, then you may include all the vehicles on one digital claim form. However, if the subject damaged vehicles were involved in different incidents or accidents, then you must file a separate digital Comprehensive Claim form for each vehicle.

Please note that your comprehensive claim will be denied if there is no record of an RM1 in the Statewide, State Vehicle Accident Reporting System (SVAR). The RM1 must be filed promptly by using the digital form on our website. Lastly, please complete this claim submittal form, and upload the State Intragovernmental Voucher Form, only after confirming that an RM1 was filed.

Lastly, if the State vehicle(s) in question is leased or rented, and is covered by private insurance, under the agreement or contract, your agency must file a claim with the insurance company first. Once you receive a final determination letter from the insurance company, you may submit a claim with our office to recover any costs or expenses that the insurance company denied.

Note: Damage to State Vehicles and Motorized Equipment resulting from a Declared Natural Disaster (Hurricane, Flood, Wind Damage, etc.) involving FEMA: If your Agency’s State Vehicle(s) sustained damage due to a declared natural Disaster, please do not file a claim or a Project Worksheet (PW) with FEMA to recover the damages and costs. Pursuant to a November 5, 2020 agreement between FEMA and the �ǿ����޴�ýapp Division of Risk Management (“DRM”), the only source of recovery for State Agencies is the “Comprehensive Claims Program” administered by DRM, which may be filed using this digital claim form.

1.  The State agency may file two (2) separate claims, one for Comprehensive and a second one for Subrogation, when the non-collision (comprehensive) damage to the State vehicle was clearly caused by an identified third person (non-state employee), and/or a third party entity.
2. The State agency may file two (2) separate claims, one for Damage to State Property and a second one for Subrogation when damage to the State property (non-state vehicle) was clearly caused by an identified third person (non-state employee), and/or a third party entity.
3. The State agency may file two (2) separate claims, one for Comprehensive Claim for Damages to State Vehicles, and a second one for Damage to State Property when State vehicles parked at the building location, and the building-facility or its contents suffer damage due to an event (flood, wind, fire, etc.)