COLQUITT COUNTY BOARD OF COMMISSIONERS

101 East Central Avenue

Request for Proposal

October 19, 2026

RE: Request for Proposal for Workers’ Compensation

Colquitt County Board of Commissioners will receive proposals for Workers’ Compensation Insurance.

Proposals will be received by the Colquitt County Purchasing Department, located in the Colquitt County Court House Annex, 101 East Central Avenue, Room 206, Moultrie Ga 31768, (PO Box 517, Moultrie Ga 31776-0517) until 10:00 AM on Thursday, November 19, 2026 at which time they will be publicly opened and read aloud. It is the bidder’s responsibility to have proposals turned in by the called time. No proposals will be accepted after this date and time.

Complete proposal documents may be obtained at the Colquitt County Purchasing Office at the Colquitt County Annex, 101 East Central Ave, Room 206 or be accessed on the Colquitt County website at www.colquittcountyga.gov/departments/purchasing and refer to the Bid and RFP list to download this packet. Bid documents may also be obtained by email request to lena.mercer@colquittcountyga.gov or 229-616-7087.

The contract, if awarded, will be for a one-year period, beginning January 1, 2027, with the option for additional one year renewals each year.

No proposal may be withdrawn for a period of 30 days.

Any and all questions are to be directed to Melissa Lawson, County Clerk at melissa.lawson@colquittcountyga.gov or 229-616-7409.

Thank you, Lena Mercer Purchasing Agent Colquitt County

District1 Commissioner

CHRIS HUNNICUTT

District2 Commissioner

MARC DEMOTT

District3 Commissioner

MIKE BOYD

DENVER F. BRASWELL

Chairman

BARBARA JELKS

District4 Commissioner

PAUL NAGY

District5 Commissioner

JOHNNY HARDIN

District6 Commissioner

CHARLES H. CANNON, IV

County Administrator 229-616-7404

MELISSA E. LAWSON

County Clerk 229-616-7409

LESTER CASTELLOW

County Attorney Post Office Box 190 Moultrie, Georgia 31776-0190 229-985-1213 Post Office Box 517

Moultrie, Georgia 31776-0517 Phone 229-616-7400

Facsimile 229-616-7018 www.colquittcountyga.gov http://www.colquittcountyga.gov/departments/purchasing mailto:lena.mercer@colquittcountyga.gov mailto:melissa.lawson@colquittcountyga.gov

Request for Proposals (RFP) Workers’ Compensation Insurance

Notice is hereby given that the Colquitt County Board of Commissioners will receive competitive proposals for the following service:

Workers’ Compensation Insurance You are invited to submit a proposal on the attached specifications. The Colquitt County Board of Commissioners will be the awarding authority. The right to reject any RFP and also waive any minor informalities or irregularities is reserved and at the sole discretion of the County. The County further reserves the right to choose the most advantageous insurance coverage that is in the best interest of the County.

Complete proposal documents may be obtained at the Colquitt County Purchasing Office or by email request to lena.mercer@colquittcountyga.gov or 229-616-7087. Bid documents may also be obtained from the www.colquittcountyga.gov website on the Purchasing web page.

Contract, if awarded, will be for one year period, beginning in January 1, 2027, with option for additional one year renewals each year.

All responses must be sealed and the words “Workers’ Compensation Insurance” and the Vendor marked on the outside of package.

This proposal must be signed by a company officer who is legally authorized to enter into a contractual relationship in the name of the vendor. The package must contain the original and four (4) copies of the proposal being submitted.

GENERAL INFORMATION

Colquitt County Government is requesting proposals from qualified individuals and firms with experience in providing the “Best Coverage” for the “Best Premium”.

The County accepts no responsibility for any expenses incurred by the responders to this RFP. Such expenses are to be borne exclusively by the responders.

QUESTIONS

All questions regarding this RFP must be in writing and addressed to the County Clerk at melissa.lawson@colquittcountyga.gov or faxed to 229-616-7409. These questions must allow sufficient time for distribution of the answers to be sent to all interested parties.

Proposals submitted in response to this RFP must be valid for a period of (90) ninety days from proposal submission deadline and must be so marked.

OPEN RECORDS ACT

Without regard to any designation made by the person or entity making a submission, Colquitt County considers all information submitted in response to this invitation or request to be a public record that will be submitted upon request pursuant to the Georgia Open Records Act, O.C.G.A. §50-18-70 et seq., without consulting or contacting the person or entity making the submission unless a court order is present with the submission. You may consult an attorney or obtain legal advice prior to making a submission.

mailto:lena.mercer@colquittcountyga.gov http://www.colquittcountyga.gov/ mailto:melissa.lawson@colquittcountyga.gov

AWARD OF CONTRACT

A selection committee will review and rate all proposals and will determine which of the firms whose proposals are highest rated based on qualifications and information provided in the proposal. After the review is completed, the committee may enter into negotiations with one or more of the vendors. The committee’s recommendations for the award will go to the Colquitt County Board of Commissioners, who will make the final decision as to the award of the contract.

The County reserves the right to waive compliance by any applicant with any provision contained in this request whenever the County in its sole discretion believes such waiver is in the County’s best interest.

RFP Requirements

Agent/Broker Requirements

1. Broker/Agent must have at least 5 years’ experience in providing services to public entity clients in Georgia.

2. Broker/Agent must provide three client references in Georgia (from Counties or

Municipalities), who are able to comment on your firm’s relevant experience.

3. Broker/Agent must provide evidence of State of Georgia insurance license.

4. Broker/Agent must provide comprehensive insurance placement services, including but not limited to providing confirmation of coverage, reviewing and delivering policies and endorsements, providing timely invoicing, issuing certificates and evidences of coverage, reviewing audits, filing claims, and monitoring insurer solvency.

5. Broker/Agent must disclose all fees and/or commissions related to services provided to the County.

6. Broker/Agent must provide evidence of insurance satisfactory to the County with the following minimum limits. County must be listed as an additional insured for general liability.

• General Liability - $1,000,000 per occurrence

• Auto Liability - $1,000,000 per occurrence

• Workers’ Compensation – Statutory Limits

• Professional Liability - $2,000,000

Insurance Carrier Requirements

1. Carrier must insure minimum of 5 Georgia county or municipal clients.

2. Carrier must have a minimum AM Best Rating of A, VIII or better, or be an authorized group self-insurance workers’ compensation fund in good standing with the Office of Insurance and Safety Fire Commissioner of Georgia.

3. Carrier must have available claims and loss control staff with Georgia public entity experience.

Coverage Specifications:

Coverage Period: January 1, 2027 – January 1, 2028

Limit of indemnity for each accident or for each employee for occupational disease:

Part One: Workers’ Compensation Bodily Injury by Accident Statutory—Each Accident Bodily Injury by Disease Statutory—Each Employee

Part Two: Employers' Liability Bodily Injury by Accident $2,000,000—Each Accident Bodily Injury by Disease $2,000,000—Each Employee

Deductible: $0

Exposure Information:

Total Payroll: $14,264,758.62

Total Full-Time Employees: 266

Total Part-Time Employees: 2

Payroll by Classification:

5506 Street or Road Construction $1,239,262 7720 Police Officers & Drivers $6,999,138 8380 Auto Repair Shop & Drivers $313,055 8810 Clerical $4,451,961 9102 Park Maintenance $5,389 9403 Garbage Collection & Drivers $686,992 9410 Municipal Employees $568,962

RFP WORKERS’ COMPENSATION INSURANCE

VENDOR INFORMATION SHEET

1. Legal Business Name ___________________________________

2. Street Address ________________________________________

3. City, State & Zip _______________________________________

4. Type of Business: ___________ State of Registration: _______

(Association, Corporation, Partnership, Limited Liability Co., etc.)

5. Name of Authorized Signer _____________________________

6. Primary Contact _______________________________________

7. Telephone ____________________ Fax ___________________

8. E-mail _______________________________________________

9. Has your company ever been debarred from doing business with any federal, state or local agency. ________________ If yes, please state the agency name, dates and reason for debarment.

Attach a Copy of Business License and Completed W-9 Form

VENDOR’S PRICE PROPOSAL FORM

Company Name _________________________________________________________

The following proposal is offered to Colquitt County on the following coverage under the current limits provided in the RFP:

Policy Period January 1, 2027, through January 31, 2028

Proposed Carrier

Limit of Liability per occurrence $

Deductible $

* Annual Premium $

* Vendor must attach documentation that supports the coverage description quoted under the annual premium. (i.e. Summary of Insurance)

Authorized Signature Title

Print Name Date

VENDOR’S REFERENCE FORM

All references must be from customers for whom your company has completed work similar to the specifications of this proposal. Attach additional page if necessary.

REFERENCES

1. Company name ____________________________________________________

Street address ______________________________________________________

City, State, Zip _____________________________________________________

Contact Person _______________________________Title _________________

Phone________________ Fax_________________ Email __________________

Describe Scope of Work and dates of project/service:

2. Company name ____________________________________________________

City, State, Zip _____________________________________________________

Contact Person _______________________________Title _________________

Phone________________ Fax_________________ Email __________________

3. Company name ____________________________________________________

City, State, Zip _____________________________________________________

Contact Person _______________________________Title _________________

Phone________________ Fax_________________ Email __________________

ACCG

ACCG2Line

STARS

Report Name:

Report Name: Colquitt County Workers' Compensation Loss Runs

Reset Page Number emplate Name: ACCG2Line Run By: Thompson, Joe eport Category: Other Created By: Thompson, Joe

Yes Asc Yes No

Sort Criteria:

Field Group Sort Order Group Total Page Break

No

2) Department Yes Asc Yes No No

1) Policy Date

Other Info:

Incurred Formula: Net Incurred

Prior Valuation: 8/17/2026 By Occurrence: No

Include Incidents: No Include Voided Claims: No

STARS Client: GSIWCF

Selection Criteria:

(Member [Claim, LocationID] equals Colquitt County and Loss Date [Claim, LossDate] is on or after Friday, January 1, 2021 and Status [Claim, Status] includes any Final, Open, Reopened )

8/17/2026

10:54:16 AM

ACCG

ACCG2Line Valued as of : 8/17/2026

Total Net

Claim Number Loss Date Location Examiner Cov

STARS

Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov

Incurred Incurred Incurred Incurred Incurred Paid Paid Paid Paid Paid

Description of Loss Report Date Cause Status Carr

Policy Date: 2021 Department: 1 - Sheriff's Office

7250098559 2/19/2021 1430 Nilson, Lori 10 0.00 0.00 4.00 0.00 4.00 Left Hand/Contusion, Altercation with 2/22/2021 89 7/28/2021 ACCG 0.00 0.00 4.00 0.00 4.00

7250100395 9/13/2021 1430 Nilson, Lori 10 36.60 0.00 1,179.30 Finger/Contusion, Door shut on finger. 9/28/2021 79 4/19/2022 ACCG

7250100396 9/11/2021 1430 Nilson, Lori

1,142.70 0.00

0.00 26.20 0.00 560.48

1,142.70 0.00 36.60 0.00 1,179.30

9/28/2021 29 5/ 9/2022 ACCG 534.28

10 534.28

0.00 26.20 0.00 560.48

7250098557 1/22/2021 1430 Nilson, Lori 10

Buttocks/Contusion, Fell during foot

76.41 0.00 836.93 Exposure to Used Syringe, Stuck with syringe while testing contents.

2/22/2021 17 10/ 7/2021 ACCG

7250098558 1/25/2021 1430 Davis, Kevin

760.52 0.00

0.00 0.00 0.00 0.00

760.52 0.00 76.41 0.00 836.93

2/22/2021 85 2/22/2021 ACCG 0.00

10 0.00

0.00 0.00 0.00 0.00

7250098989 4/14/2021 1430 Benson, Alan 10

Lower Leg/Contusion, Bitten by dog.

63.69 0.00 4,361.13 Right Knee/Strain, Foot pursuit of 4/15/2021 89 1/10/2023 ACCG

7250098991 4/14/2021 1430 Nilson, Lori

3,754.59 542.85

0.00 8.39 0.00 118.28

3,754.59 542.85 63.69 0.00 4,361.13

4/15/2021 57 11/ 9/2021 ACCG 109.89

10 109.89

0.00 8.39 0.00 118.28

7250099234 5/4/2021 1430 Nilson, Lori 10

Shoulder/Strain, Turning wheel without turning the steering wheel with no power steering.

15.39 0.00 348.49 Wrist/Contusion, Arresting suspect. 5/18/2021 89 11/ 9/2021 ACCG

7250099486 5/19/2021 1430 Davis, Kevin

333.10 0.00

0.00

333.10 0.00 15.39 0.00 348.49

0.00 10 0.00 0.00 0.00 0.00

Policy Date: 2021 7250099489 2/28/2021 1430 Mobley, Tess

Lower Extremities/Strain, Did a split. 6/14/2021 29 6/14/2021 ACCG

183,178.91 10,643.16 0.00 283,363.16

0.00 0.00 0.00 0.00

6/14/2021 57 8/24/2023 ACCG 89,541.09

10 89,541.09

183,178.91 10,643.16 0.00 283,363.16

7250099572 6/14/2021 1430 Nilson, Lori 10

LEFT SHOULDER/Strain, Attempting to stop vehicle from rolling away.

23.01 0.00 941.43 LEFT KNEE/Sprain, Altercation with 6/23/2021 89 11/ 9/2021 ACCG

7250099624 6/23/2021 1430 Nilson, Lori

918.42 0.00

0.00 17.56 0.00 92.56

918.42 0.00 23.01 0.00 941.43

6/28/2021 68 11/ 9/2021 ACCG 75.00

10 75.00

0.00 17.56 0.00 92.56Elbow/Contusion, Struck console.

https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523849 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526975 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523847 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523848 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524666 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524668 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525106 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525510 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525514 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525647 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525726

7250099759 7/3/2021 1430 Davis, Kevin 10 0.00 0.00 0.00 Right Knee/Contusion, Tripped on drain and fell.

7/12/2021 29 7/14/2021 ACCG

7250100397 9/2/2021 1430 Nilson, Lori

0.00 0.00

0.00 4.00 0.00 4.00

0.00 0.00 0.00 0.00 0.00

9/28/2021 85 4/19/2022 ACCG 0.00

10 0.00

0.00 4.00 0.00 4.00

7250100398 9/16/2021 1430 Davis, Kevin 10

Left Knee/Puncture, Bug Bite.

0.00 0.00 0.00 Buttocks/Contusion, Fell. 9/28/2021 29 9/28/2021 ACCG

7250100680 10/26/2021 1430 Gore, Kattie

0.00 0.00

0.00 98.08 0.00 3,027.73

0.00 0.00 0.00 0.00 0.00

11/4/2021 68 9/12/2022 ACCG 2,929.65

10 2,929.65

0.00 98.08 0.00 3,027.73

7250100733 11/4/2021 1430 Mansaray, Gra10

Head/Concussion, Struck head entering vehicle.

1,705.75 5,062.43 31.01 0.00 6,799.19 Left Index Finger/Fracture, Student struggled while being escorted to In School Suspension.

11/10/2021 89 2/13/2023 ACCG 1,705.75 5,062.43 31.01 0.00 6,799.19

Total by Department 17 Claim 101,804.99 188,784.19 11,047.50 0.00 301,636.68 101,804.99 188,784.19 11,047.50 0.00 301,636.68

Department: 12 - Emergency Medical Services / 911 Policy Date: 2021 7250098327 1/12/2021 1430 Nilson, Lori 10 501.00 0.00 95.74 0.00 596.74 Carpal Tunnel, constant use of keyboard 1/25/2021 97 8/25/2022 ACCG 501.00 0.00 95.74 0.00 596.74

Total by Department 1 Claim 501.00 0.00 95.74 0.00 596.74

501.00 0.00 95.74 0.00 596.74

Department: 19 - Public Works

0.00 0.00 0.00

Right Shoulder/Contusion, Fell on steps. 6/24/2021 33 6/24/2021 ACCG 7250099604 6/24/2021

7250099757 7/8/2021 1430 Nilson, Lori

0.00 0.001430 Davis, Kevin 10

0.00 50.39 0.00 1,815.57

0.00 0.00 0.00 0.00 0.00

7/12/2021 56 6/ 7/2022 ACCG 1,765.18

10 1,765.18

0.00 50.39 0.00 1,815.57

7250099758 7/8/2021 1430 Mansaray, Gra10

Right Shoulder/Strain, Throwing chairs into a truck.

59.92 0.00 2,332.88 Lower Back/Strain, Pulling wood. 7/12/2021 57 2/17/2022 ACCG

7250099966 8/5/2021 1430 Mansaray, Gra

1,703.70 569.26

3,283.74 76.36 0.00 7,175.54

1,703.70 569.26 59.92 0.00 2,332.88

8/9/2021 56 8/16/2022 ACCG 3,815.44

10 3,815.44

3,283.74 76.36 0.00 7,175.54

7250100402 9/24/2021 1430 Nilson, Lori 10

Right Shoulder/Strain, Lifting log.

4.00 0.00 4.00 Left Knee/Contusion, Fell. 9/28/2021 29 4/19/2022 ACCG

7250100512 10/11/2021 1430 Mansaray, Gra

0.00 0.00

0.00 98.96 0.00 1,960.18

0.00 0.00 4.00 0.00 4.00

10/12/2021 45 7/ 1/2022 ACCG 1,861.22

10 1,861.22

0.00 98.96 0.00 1,960.18

7250101037 12/20/2021 1430 Davis, Kevin 10

Head & Shoulder/Contusion, MVA-

0.00 0.00 0.00 0.00 0.00 Ankle/Sprain, Exiting equipment. 12/21/2021 53 12/22/2021 ACCG 0.00 0.00 0.00 0.00 0.00

Total by Department 7 Claim 9,145.54 3,853.00 289.63 0.00 13,288.17 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525934 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526976 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526977 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527486 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527574 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523436 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525690 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525932 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525933 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526307 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=526981 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527164 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528101

9,145.54 3,853.00 289.63 0.00 13,288.17 Policy Date: 2021

Department: 29 - Prison Operations 7250098702 3/6/2021 1430 Benson, Alan 10 0.00 0.00 5,683.69 0.00 5,683.69 Lower Leg/Contusion, Altercation with inmate.

3/11/2021 89 7/29/2021 ACCG 0.00 0.00 5,683.69 0.00 5,683.69

7250098959 4/7/2021 1430 Nilson, Lori 10 75.00 0.00 16.76 0.00 91.76 Ankle/Strain, Stepping off the stairs. 4/13/2021 33 7/28/2021 ACCG 75.00 0.00 16.76 0.00 91.76

Total by Department 2 Claim 75.00 0.00 5,700.45 0.00 5,775.45

75.00 0.00 5,700.45 0.00 5,775.45

Department: 6 - Clerical 7250098703 2/25/2021 1430 Nilson, Lori 10 75.00 Head/Laceration, Struck head on handrail on stairwell.

3/11/2021 68 5/12/2021 ACCG 75.00

75.00 0.00 16.76 0.00 91.76

0.00 16.76 0.00 91.76

0.00 16.76 0.00 91.76 Department: 9 - Landfill / Sanitation / Recycling

0.00 16.76 0.00 91.76

Total by Department 1 Claim

7250098834 3/23/2021 1430 Nilson, Lori 10

75.00

1,752.77 0.00 77.71 0.00 1,830.48 Hand/Laceration-Using knife to cut item at work

3/29/2021 17 9/10/2021 ACCG 1,752.77 0.00 77.71 0.00 1,830.48

7250099235 5/11/2021 1430 Nilson, Lori 10 109.89 0.00 8.39 0.00 118.28 Eye/Laceration, Handle struck eye. 5/18/2021 78 11/ 9/2021 ACCG 109.89 0.00 8.39 0.00 118.28

Total by Department 2 Claim 1,862.66 0.00 86.10 0.00 1,948.76 1,862.66 0.00 86.10 0.00 1,948.76

Total by Policy Date 30 Claim 113,464.19 192,637.19 17,236.18 0.00 323,337.56 113,464.19 192,637.19 17,236.18 0.00 323,337.56

Policy Date: 2022 Department: 1 - Sheriff's Office

Policy Date: 2022 725010236302 6/5/2022 1430 Nilson, Lori 10 574.72 0.00 25.55 0.00 600.27 Shoulder/Contusion, Altercation during involuntary committal.

6/7/2022 89 2/15/2023 ACCG 574.72 0.00 25.55 0.00 600.27

7250102886 7/28/2022 1430 Mansaray, Gra10 40.74 0.00 119.08 Trunk/Strain, Lifting furniture. 8/4/2022 56 2/13/2023 ACCG

725010236301 6/5/2022 1430 Nilson, Lori

78.34 0.00

0.00 13.83 0.00 488.84

78.34 0.00 40.74 0.00 119.08

6/7/2022 89 2/13/2023 ACCG 475.01

10 475.01

0.00 13.83 0.00 488.84

7250102695 7/12/2022 1430 Benson, Alan 10

Lower Back/Multiple Injury, Altercation during involuntary committal.

1,154.19 0.00 65,635.76 Left Knee/Strain, Exiting vehicle. 7/18/2022 53 5/29/2025 ACCG

7250103091 8/25/2022 1430 Davis, Kevin

34,886.03 29,595.54

0.00 0.00 0.00 0.00

34,886.03 29,595.54 1,154.19 0.00 65,635.76

8/29/2022 89 8/29/2022 ACCG 0.00

10 0.00

0.00 0.00 0.00 0.00Right Wrist & Face/Contusion, Altercation with inmate.

https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524126 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524127 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=524378 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525107 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530417 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531299 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530416 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531664

725010311201 8/25/2022 1430 Nilson, Lori 10 15.44 0.00 820.74 Left Hand/Puncture, Cut hand on fence during foot pursuit.

8/30/2022 17 4/19/2023 ACCG

725010311202 8/25/2022 1430 Nilson, Lori

805.30 0.00

0.00 44.53 0.00 350.14

805.30 0.00 15.44 0.00 820.74

8/30/2022 29 4/19/2023 ACCG 305.61

10 305.61

0.00 44.53 0.00 350.14

7250103491 6/27/2022 1430 Nilson, Lori 10

Knees & Hand/Contusion, Fell during foot pursuit.

4.00 0.00 4.00 Right Knee/Contusion, Altercation with inmate.

10/17/2022 89 4/19/2023 ACCG

7250103749 10/27/2022 1430 Mansaray, Gra

0.00 0.00

29,701.80

0.00 0.00 4.00 0.00 4.00

20,965.14 10 20,965.14 7,798.98 937.68 0.00

Policy Date: 2022 7250103863 10/8/2022 1430 Nilson, Lori

Left Shoulder/Strain, Tripped & Fell. 11/17/2022 29 8/ 6/2026 ACCG

0.00 14.28 0.00 582.82

7,798.98 937.68 0.00 29,701.80

12/5/2022 85 4/19/2023 ACCG 568.54

10 568.54

0.00 14.28 0.00 582.82

7250103864 11/27/2022 1430 Nilson, Lori 10

Left Lower Leg/Contusion, Dog Bite.

164.08 0.00 3,642.40 Right Knee/Strain, Altercation with 12/5/2022 89 11/ 2/2023 ACCG

7250104958 12/24/2022 1430 Benson, Alan

3,478.32 0.00

16.20

3,478.32 0.00 164.08 0.00 3,642.40

0.00 10 0.00 0.00 16.20 0.00

62,137.01 37,394.52 2,430.52 0.00 101,962.05

Neck/Inflammation, Getting out of 4/19/2023 53 11/ 2/2023 ACCG

37,394.52 2,430.52 0.00 101,962.05 Department: 17 - Fleet Maintenance

0.00 16.20 0.00 16.20

Total by Department 12 Claim

7250102232 5/19/2022 1430 Benson, Alan 10

62,137.01

7,014.39 0.00 317.49 0.00 7,331.88 Left Wrist/Strain, Installing an O-Ring. 5/23/2022 57 2/15/2023 ACCG 7,014.39 0.00 317.49 0.00 7,331.88

Total by Department 1 Claim 7,014.39 0.00 317.49 0.00 7,331.88 7,014.39 0.00 317.49 0.00 7,331.88

Department: 19 - Public Works 7250102191 5/18/2022 1430 Nilson, Lori 10 544.22 0.00 66.75 0.00 610.97 Right Shoulder/Strain, Injured using asphalt rake.

5/19/2022 59 11/ 2/2023 ACCG 544.22 0.00 66.75 0.00 610.97

7250103217 9/7/2022 1430 Nilson, Lori 10 44.09 0.00 244.38 Chest/Contusion, Struck on right side of the ribs while placing tamp on truck.

9/13/2022 79 3/10/2023 ACCG

7250103750 9/20/2022 1430 Mansaray, Gra

200.29 0.00

54,724.57

200.29 0.00 44.09 0.00 244.38

38,364.26 10 38,364.26 12,813.82 3,546.49 0.00

Policy Date: 2022 7250101443 2/17/2022 1430 Nilson, Lori

R. Shoulder/Strain, Unloading truck. 11/17/2022 56 8/ 8/2025 ACCG

0.00 23.77 0.00 818.08

12,813.82 3,546.49 0.00 54,724.57

2/18/2022 25 8/16/2022 ACCG 794.31

10 794.31

0.00 23.77 0.00 818.08

7250102194 5/5/2022 1430 Mansaray, Gra10

Elbow, knee & ankle/Contusion, Slipped & Fell.

17.30 0.00 17.30 Groin/Strain, Reinjured groin exiting 5/19/2022 53 4/19/2023 ACCG

0.00 0.00

0.00 0.00 17.30 0.00 17.30 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531695 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531695 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531695 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531695 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531695 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531697 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531697 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531697 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531697 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531697 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532359 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532359 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532359 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532359 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532359 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532811 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532811 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532811 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532811 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532811 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533009 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533010 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533010 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533010 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533010 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533010 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535002 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535002 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535002 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535002 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535002 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530195 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530195 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530195 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530195 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530195 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530137 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530137 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530137 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530137…