Local Government Risk Management Plan - Commonwealth Of Virginia (Page 2 of 2) in pdf

Page 2 of 2

Revised 11/2000

H. Number of Employees

(other than School and Law Enforcement personnel):

Full Time Employees ________ Part Time Employees ________ Volunteers ________

I. Complete if Law Enforcement Coverage is requested

1. Number of Full Time Officers with Arrest Authority______________________________

2. Number of Part Time Officers with Arrest Authority _____________________________

3. Number of Support Staff without Arrest Authority_______________________________

Date of last authorized revised policy and procedures manual_______________________

Do you have written policies governing:

1. Vehicle responding to calls? Yes

Policy Date ______________________

2. Vehicle “Hot Pursuit”?

Yes

Policy Date ______________________

3. Use of deadly force?

Yes

Policy Date ______________________

4. Use of non-deadly force?

Yes

Policy Date ______________________

Law Enforcement Contact: Name_____________________________________________

Title____________________________________ Phone Number____________________

Law Enforcement Claims History for Past Three Years

(Please explain in detail and attach

additional sheets if necessary.)

Number

Year

of Claims

Description

Cost Estimate

________________________________________________________________________

J. Please complete if Educator’s Liability coverage is requested:

Number of Full Time Teachers____________ Number of Part Time Teachers __________

Number of Administrators/Support Staff___________ Number of Volunteers____________

Number of Students_________ Other positions (Specify)___________________________

___________________________________________________________________________

K. PRINT the Name and title of official designated to receive all information regarding the

VaRISK 2 Plan at the address listed in Section A.

Name__________________________________ Title_____________________________

I. The UNDERSIGNED certifies all information herein is accurate.

Name_________________________________________ Date______________________

(signature of the person named in K. Above)

Local Government Risk Management Plan - Commonwealth Of Virginia Page 2