WC ICA Self insurance Renewal Ltr 12-2-2021

December 1, 2021 
 
Industrial Commission of Arizona 
Attn:  Renee Pastor 
Self-Insurance Manager 
800 W. Washington, Suite 301 
Phoenix, AZ  85007 
 
RE:  2022 Self-Insurance Renewal Request and Request for Exemption from 
Requirement to Post Statutory Deposit 
 
Dear Ms. Pastor: 
 
The City of Glendale submits its documentation for self-insurance authority.  The City of 
Glendale, a public entity, meets the condition required under R20-5-1114 (A).  Resolution 
No. 00-00 was passed by the City Council on 11/23/2021, meeting the conditions outlined 
in R20-5-1114(A).  I have provided the Council Report and a copy of the unsigned 
resolution.  A copy of the resolution will be provided to the Commission once it is signed.  
 
1. Attached is the complete Workers’ Compensation Liability form, accompanied 
by a loss run that supplies individual claim backup information.  The 
evaluation date is October 31, 2021. 
 
2. Attached is the City of Glendale’s loss run, referenced above.  
 
3. The City of Glendale is a public entity and will be requesting an exemption to 
post the security deposit under item 6, below. 
 
4. A copy of the City Excess insurance policy is attached.  The completed Excess 
Recovery Claims form, as well as a copy of the 2021 letters requesting excess 
reimbursement are attached.  
 
5. Attached is the UNAUDITED Statement of Revenues, Expenses and Changes 
in Fund Net Assets – Budget Basis for the period 7/1/2021 through 
10/28/2021.  The City’s trust fund balance is $14,018,812.42.  The City’s Annual 
Financial Report (CAFR) will be available after December 31, 2021.  When it 
becomes available it can be found at www.glendaleaz.com/finance.

2022 ICA Self Insurance Renewal & Request for Exemption from Requirement to Post Statutory Deposit 
November 2021 
Page 2 of 3 
 
 
6. The City is requesting continuing an exemption from positing required 
security deposit pursuant to Rule 20-5-1114.  The City has an established 
Workers’ Compensation trust fund for payment of workers’ compensation 
claims pursuant to A.R.S. § 11-981 and in accordance with City Ordinance 
Chapter 2, Administration, Article V., Financial Affairs, Division 6, Workers’ 
Compensation Trust Fund. 
 
7. The City of Glendale’s denial rate was 6.0% and is below the ICA’s 12% 
standard or the average denial rate for City and County employers of 8.1%.  
 
8.   The City of Glendale has 2217 employees. 
 
9. The City’s Third-Party Administrator: 
 
CorVel Corporation 
1850 North Central Avenue, #1200 
Phoenix, AZ  85004 
Tel. 602-288-1838 Fax 866-392-2919 
 
10.   The City of Glendale points of contact: 
     
Dianne Shoemake 
 
 
Lorena Sanchez-Zumph 
Risk Manager  
 
 
 
HR Program Manager  
5850 West Glendale Avenue  
5850 West Glendale Avenue 
Glendale, AZ  85301 
 
 
Glendale, AZ  85301 
Tel.:  (623) 930-2856 
 
 
Tel.:  (623) 930-2857 
Fax:  (623) 915-2697 
 
 
Fax:  (623) 847-5322 
dshoemake@glendaleaz.com  
lsanchez@gendaleaz.com 
 
11. The Commission determined the City of Glendale’s 2019 EMF at 0.97. 
 
12. The City of Glendale conducts an annual actuary report.  Attached is actuarial 
study conducted by AON Risk Consultants as of June 30, 2021.  
 
13. The City of Glendale CAFR recommends a 55% confidence level. 
 
14. The City of Glendale uses 0.51% discount percentage for investment returns.  
 
 
We would be glad to discuss any concerns that you have, answer any questions or 
provide additional documentation regarding the administration of the Workers’ 
Compensation Trust Fund.

2022 ICA Self Insurance Renewal & Request for Exemption from Requirement to Post Statutory Deposit 
November 2021 
Page 3 of 3 
 
 
Sincerely, 
 
 
 
Dianne Shoemake 
Risk Manager 
 
Enclosures: 
Workers Compensation Liability Form 
Open Claims and Excess Recovery Loss Run 
Excess Insurance Policy 
Letters to Excess Carrier  
Unaudited Statement of Revenues, Expenses and Changes in Fund Net Assets – Budget Basis 
Actuarial Report - AON Risk Consultants