Exhibit_J-1._Law_Enforcement_Liability_Application.pdf

1. Description of Operations:

2. Do you have any State/County/National Accreditations? Yes No

If yes, please describe:

3. What is the current annual operating budget for the law enforcement agency?

4. What is the total annual operating budget for municipality/county?

5. Are you a party to any Mutual Aid Agreements or Multi-Agency Task Forces? Yes No If yes, with whom?

6. Do you provide contracted services for any other entities? Yes No; If yes, with whom?

7. Advise Coverage Requested: Law Enforcement Jail Operations Only Both

8. Does your current policy include coverage for your detention facilities? Yes No

9. Exposure Information:

Armed (# of Employees) Unarmed (# of Employees)

Sworn Officers (Full Time)

Sworn Officers (Part Time)

Auxiliary / Reserve Officers

Civil Process Officers

Court Security Officers

No. of Jailors (Full-Time)

No. of Jailors (Part-Time)

Total Number of Employees

Yes No

Yes No

10. Are the following positions to be insured?

County Sheriff / Police Chief

District Attorney Investigators

D.A. or Prosecuting attorneys Yes No

Ambridge Group

Law Enforcement Liability application This application will be attached to and become a part of the policy.

I. GENERAL INFORMATION

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EXHIBIT J

II. HIRING AND TRAINING

Law Enforcement Liability application continued

11. What are the minimum educational requirements for applicants?

High School Diploma or equivalent? Yes No

30 or more hours of college? Yes No

60 or more hours of college? Yes No

Bachelor’s degree? Yes No

12. Do all officers receive training in Yes No simulated or actual high speed pursuit?

13. Do all officers receive training in:

First Aid? Yes No

CPR? Yes No

Use of defibrillators? Yes No

14. What training is required of reserve and auxiliary officers?

Same as full-time officers?

Less than full-time officers?

If less, explain below:

Does it exceed State Minimum requirements? Yes No

15. Do you follow written policies regarding Yes No in-service training or continuing education for all officers?

16. Is all employee training, both past and Yes No present, documented and kept on file?

a. Are employee records: electronic paper

17. What training of correctional officers/jailors is required prior to hiring?

Full Time Formal Academy? Yes No

Number of Hours

Part Time Formal Academy? Yes No

Number of Hours

18. Does your agency have a Field Training Program for new cadets? Yes No

If yes, how many weeks?

19. Which of the following are included in your selection process prior to employment?

Written Exam? Yes No

Psychological Exam? Yes No

Professional psychological evaluation? Yes No

Background and employment investigation? Yes No

Physical Fitness Testing Yes No

20. How often are officers certified and trained for the following?

Department issued handgun annual bi-annual other

Personal (off-duty) handgun annual bi-annual other

Mace/Chemicals annual bi-annual other

Baton annual bi-annual other

Canine Handling annual bi-annual other

Taser annual bi-annual other

Narcan annual bi-annual other

Other, annual bi-annual other

If other, please describe:

21. Does the agency require Yes No de-escalation training for all law enforcement officers?

If yes, how often?

22. Does the agency require training Yes No on bias-free policing/implicit bias?

If yes, how often?

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III. POLICIES AND PROCEDURES

23. Do you maintain a formal Policies and Yes No Procedures Manual?

24. Do all employees maintain their own copy? Yes No

25. Do all employees sign off that they are held Yes No accountable for knowing the contents of the employee handbook?

26. When was your manual originally assembled?

27. When was your manual last updated?

28. Is there a policy that requires warning Yes No before discharging a weapon?

29. Is there a policy a place that prohibits Yes No the discharging a weapon at/from moving vehicles?

30. a. Does the agency track citizen Yes No complaints by officer?

b. Does the agency utilize a civilian review Yes No committee when investigating citizen complaints?

32. Does the agency have a policy that requires officers report use of force against civilians Yes No officers to report each time they use force or threaten to use force against civilians?

a. Are reports followed up? Yes No

If no, explain:

33. Is there a “Duty to Intervene” policy in place requiring officers intervene and stop suspected excessive Yes No use of force by another officer and immediately report to a supervisor?

Attachment: Please attach a copy of your current Law Enforcement Policies and Procedures Manual

31. Do you have formal written policies and procedures pertaining to the following subjects:

Last Updated MM/DD/YY

Use of deadly force. Yes No Use of less-lethal force. Yes No Vehicle high-speed pursuit? Yes No Domestic Violence? Yes No Stops, search and seizure? Yes No Intoxicated arrestees? Yes No Communicable diseases? Yes No Employee moonlighting? Yes No Carotid Hold? Yes No Body Worn Cameras? Yes No ADA Compliance? Yes No Police Volunteer Policy? Yes No Suicide Prevention? Yes No Drone Usage? Yes No Ride Along Policy? Yes No Social Media Policy? Yes No Crisis Communication Policy? Yes No Community Policing? Yes No

IV. RELATED OPERATIONS

34. Do you handle your own dispatching? Yes No

35. Do you dispatch for any other entities? Yes No

36. Are all incoming calls recorded? Yes No

37. How long are the tapes maintained?

38. How many hours of training do dispatchers receive?

39. Do you participate in any internship or Yes No ride-along programs? If so, please attach explanation.

40. Do you own, operate or maintain any: Yes No fixed or rotary wing aircraft?

Watercraft? Yes No

If so, please expain:

41. Do you authorize off-duty employment? Yes No

If so, who authorizes?

Is payroll processed through the entity Yes No

Is there any moonlighting in bars or taverns? Yes No

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42. Which of the following best describes your facility?

Temporary holding facility (under 8 hours – no overnight)

Temporary holding cell (from 8 to 24 hours)

Jail - for persons serving time, awaiting trial or transfer.

Prison – maximum security

43. When was your facility built?

44. When was your facility last renovated?

45. What is the state certified capacity?

46. What is the average daily inmate population?

47. Does your facility house:

Adult prisoners only? Yes No

Males and females? Yes No

Violent and non-violent prisoners? Yes No

48. How many attempted suicides have there been in your facility in the last five years?

49. Has anyone ever successfully committed Yes No suicide in your facility?

If yes, please attach explanation.

50. Do you maintain consistent separation between:

Adults and juveniles? Yes No

Males and females? Yes No

Violent and non-violent inmates? Yes No

51. Is your facility equipped with surveillance systems to monitor activity in the following areas? If so, please check.

Individual detention cells? Audio Video

Secured common areas? Audio Video

Booking area? Audio Video

Sally port? Audio Video

52. When was your facility last inspected by the following:

State Corrections Officials? date:

Fire Inspectors? date:

Department of Health? date:

53. Do you have standard fire protection Yes No systems including smoke detectors and fire alarms?

54. Do dispatchers serve as jailers? Yes No

If so, do they receive the same training? Yes No

V. DETENTION FACILITY

If you do NOT have a detention facility of any kind, please check this box and skip to the next section. No Detention Facility

55. Are there Hold Harmless Agreements used in Yes No all of the Entity’s contracts?

56. Do you have formal written policies and procedures for:

Intake screening and classification? Yes No

Medical screening? Yes No

Suicide detection and prevention? Yes No

Periodic walk-through of the facility? Yes No

Administration and control of medication? Yes No

Use of force? Yes No

Emergency evacuation? Yes No

Communicable diseases? Yes No

PREA Act Yes No

57. When was your manual last updated?

a. Is your manual reviewed by legal counsel? Yes No

58. Has your facility ever been subject to a court Yes No order or Consent Decree?

If yes, please explain:

59. Occupant’s Status:

Convicted Felon Convicted Misdemeanor

INS Detainees US Marshall Detainees

Pre-Trial Detainees

Other/Contracted (please describe):

60. Is medical clearance required before Yes No detention when drug/alcohol is involved?

61. Is monitoring done by jail personnel or Yes No medical personnel on arrests involving drug/alcohol use?

62. How does detention facility ensure cell checks are performed?

63. Do you provide inmate transport? Yes No

If yes, please describe:

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64. Please check the classification that best describes the health care services you provide:

Clinic, Dispensary or Infirmary

Mental or Psychopathic Treatment Center

Medical or Surgical Facility

Drug or Substance Abuse Treatment Center

None

Other (describe):

65. Describe the nature and type of health care you provide:

66. Number of Health Care Beds:

Square Footage of Health Care Facility:

67. Do you employ or contract with any of the following:

Doctor(s)? Employ Contract How many?

Nurse(s)? Employ Contract How many?

Dentist? Employ Contract How many?

Psychologist? Employ Contract How many?

68. Advise whether each of the following maintain their own coverage and if yes, comment the policy limits:

Professional E&O liability?

Medical malpractice?

Policy Limits:

Doctor Yes No Yes No

Nurse Yes No Yes No

Dentist Yes No Yes No

Psychologist Yes No Yes No

Law Enforcement Liability application continued

V. DETENTION FACILITY continued

69. Exposure Information:

Facility Number of Facilities

Total Square Footage

Number of Cells

Design Capacity

Average Inmate

Population

Maximum Capacity in Past

12 Months

Date Built

Jail

Holding Cell

Juvenile Detention Center

Prison

Other:

Attachment: Please provide 1.) a copy of your current Detention Facility Policies and Procedure Manual governing those areas specified above, and 2.) a copy of your latest state inspection report, if applicable.

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Law Enforcement Liability application

VI. ATTESTATION

The undersigned being authorized by, and acting on behalf of, the applicant and all persons or concerns seeking insurance, has read and understands this Application, and declares that all statements set forth herein are true, complete and accurate.

The undersigned further declares and represents that any occurrence or event taking place prior to the inception of the policy applied for, which may render inaccurate, untrue or incomplete any statement made herein will immediately be reported in writing to the insurer. The undersigned acknowledges and agrees that the applicant’s submission and Insurer’s receipt of such written report, prior to the inception of the policy applied for, is a condition precedent to coverage.

The signing of this Application does not bind the undersigned to purchase the insurance, nor does review of the Application bind the insurance company to issue a policy. The applicant does hereby agree that this policy, if issued, is issued in reliance upon the truth of this application, including all requested attachments, which will be incorporated into and made a part of this policy.

WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE

COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF

CLAIM CONTANING MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THEPURPOSE

OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A

FRAUDULENT INSURANCE ACT, WHICH IS A CRIME.

Applicant’s Authorized Signature

Title

Date

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