POLICE PROFESSIONAL LIABILITY

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1 POLICE PROFESSIONAL LIABILITY Police Loss Control Information What background checks are completed prior to hiring any officers? ( ) Motor Vehicle Records (MVRs) ( ) Employment history ( ) Criminal history ( ) References ( ) Psychological testing ( ) Drug screening ( ) Educational verification ( ) Other: ( ) Credit history Dispatch Loss Control Information Are dispatch calls recorded? How long are the tapes saved?... Do you have video recording in police vehicles? Do you have audio recording of dispatch in police vehicles?. HOLDING CELLS or JAIL OPERATIONS Do you have Holding Cells? Yes No (If Yes, complete Holding Cell or Jail Operations Supplemental Page) Do you operate a Jail? Yes No (If Yes, complete Holding Cell or Jail Operations Supplemental Page) Policies & Procedures currently in place: Does the agency have a policy & procedures manual?... *Date of last overall revision of your policy & procedure manual... *Is the manual distributed to all personnel?... *How often is the manual reviewed with personnel?... *What is the title of the person who conducts the review? *Are employees required to sign that they have reviewed the policy and procedures manual?

2 Police Professional continued Does the applicant have written policies governing the following? Yes No Policy Description Date Adopted Use of Deadly Force Use of Non-Deadly Force Domestic Violence Emergency Driving (Pursuit) Service of Warrant Communicable Disease (i.e., AIDS) Hostage Situations Handling of Intoxicated Persons Motor Vehicle Stops Ride Along Dispatching Units Use of Firearms Use of Tasers Use of OC Spray Civilian Complaints Strip Searches Carrying of off duty weapon Sexual Harassment Off Duty Employment (Moonlighting) Review the actual policy for each of the bolded items above. Comments:

3 PUBLIC OFFICIALS LIABILITY Planning & Zoning *Does your entity have a planning & zoning board? *Does your municipal attorney attend all meetings of the planning and zoning board?.. *Do zoning changes require a public hearing?. *Does the entity have a formal (written) zoning and zoning appeal process?.. *Do planning and zoning officials receive training regarding "open meeting" and hearing regulations? EMPLOYMENT PRACTICES LIABILITY Does your entity have a Human Resources Department?.. If yes, does a human resources employee review all terminations prior to dismissal?.. Does entity require terminations to be reviewed by entity's attorney?.. *Are written performance evaluations completed & communicated to employees annually?... *Is a written Personnel Policies and Procedures Manual and/or Employee Handbook distributed to all personnel? Date of last revision / / *Has the manual/handbook been reviewed by legal counsel? Date of last review / / *Does every employment position have a written job description? Does your entity have written Employment Practices type policies/procedures for: Hiring/Interviewing Background checks Performance appraisal/review Discipline Discharge/Termination/Suspension Reporting, investigation, and resolving employee complaints (grievance procedures) Sexual Harassment Medical Leave Discrimination

4 Check if you would like a quote for this coverage POLICE PROFESSIONAL LIABILITY EXPOSURE CLASSIFICATIONS Number of Full time Officers. Number of Part-time Officers Number of Reserve Officers Number of Auxiliary Officers Number of Clerical. Number of Dispatchers.. Number of Firing Range (for police use only) Number of Police Dogs*- Attack. Number of Police Dogs*- Drug & Bomb Number of Horses*. Number of Holding Cells Number of Jail Cells Include sworn school crossing guards and sworn animal control personnel in numbers above Police Type Definition: Reserve Officers: officers who are on your reserve officer call list who are paid for the hours they work but have no other benefits Auxiliary Officers: officers who are Volunteer only (no remuneration or benefits or fringe benefits for their services) You must have an ordinance in place authorizing an auxiliary police force as defined by G.S. 160A-282 *Scheduled Animal Coverage (life & health insurance) is available; complete supplemental application. Animal must be owned by your entity (not trainer) Describe any continuing in-service educational and training programs: Police Underwriting Information Has this law enforcement agency received any State accreditations?. Has this law enforcement agency received a Commission on Accreditation for Law Enforcement Agencies (CALEA) accreditation?. Number of Full-time Officers who hold Intermediate or Advanced Law Enforcement Certificate.. (if over 50% please attach list of Officers) %

5 Do you contract law enforcement to any public or private entity?.. (If yes, attach a copy of the contract) Are you part of any mutual law enforcement assistance agreements? (If yes, attach a copy of agreements) Do you authorize off duty employment?. Do you authorize off-duty employment (moonlighting) in establishments with 50% or more in sales of alcoholic beverages?...

6 Check if you would like a quote for this coverage PUBLIC OFFICIALS LIABILITY Limits of Liability (claims-made) Each Wrongful Act Limit Total Limit Have you been declined, cancelled or non-renewed in the past (3) years? If yes, Describe Each Wrongful Act Deductible Entity currently has the following type of policy in place: ( ) Occurrence ( ) Claims-made If Claims-made, Claims-made Retroactive Date: / / Type of Government: ( ) Council/Manager ( ) Mayor/Council Is your Entity responsible for issuing Building Permits? Is your Entity responsible for Zoning Changes? Operations/Service Alcoholic Beverage Control Airport Electric Utility Gas Utility Housing Authority Port Authority School Board Transit Authority Boards and Commissions Underwriting Information Does your entity Is this board or appoint members to commission under If no, who provides coverage for this Board? this Board? the control of your entity? Yes No Yes No Note: there is no coverage for Boards or Commissions unless they are under your control and endorsed onto the policy. Planning & Zoning Underwriting Information In past three years, have there been any disputes or claims alleging the wrongful granting or refusal to grant zoning changes, building permits, etc.?. In past three years, have there been any disputes or claims alleging the wrongful approval or building designs or specifications?. Number Building Permits granted in past year? Number of Building Permits denied in past year?

7 Does your entity own, operate or lease an Airport? If yes, which: ( ) Own ( ) Operate ( ) Lease Number of aviation shows Number of commercial flights daily Contract with fixed base operator? Other leases on airport property? If yes, do leases contract with entity or FBO?

8 Check if you would like a quote for this coverage EMPLOYMENT PRACTICES LIABILITY Entity currently has the following type of policy in place: ( ) Occurrence ( ) Claims Made Retroactive Date (Claims Made only) / / Has there been continuous Claims Made coverage back to the requested Retroactive Date: Limits of Liability Each Wrongful Act Limit Total Limit Each Wrongful Act Deductible Have you been declined, cancelled or non-renewed in the past (3) years? If yes, Describe Prior Acts Notification (If Yes to any of the following questions, please provide details in the Notes section) During the past (3) years, has any of the following occurred: Has there been any layoff of employees, terminations or workforce reductions?... Do you anticipate any employee layoffs or workforce reductions within the next 12 months?... Are all involuntary terminations reviewed and approved by Human Resources Manager? Are all involuntary terminations reviewed and approved by Attorney? Has any person, former employee or job applicant made any claim alleging unfair or improper treatment regarding employee hiring, remuneration, advancement or termination of employment?. Has there been any sexual harassment or civil rights claims? Has there been any disputes involving integration, segregation, discrimination or violation of civil rights?.. Has a claim been made or is a claim now pending against the Entity or any person in his/her capacity as an official or employee of the Entity? Does any official or employee have knowledge of any act, error or omission or breach of duty which may reasonably be expected to give rise to a claim against them or against the Entity?.. Is entity operating under a court order? Have you had any EEOC complaints?... If yes, please give details.

9 Employment Related Information Number of employees who have been terminated in the last year: Number of employees who have left voluntarily in the last year: Does your current policy provide employment-related practices coverage? If yes, complete the following: Carrier: Limit: Deductible: Back wages covered?. If yes, limit In prior year: In prior year:

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