Indemnity Insurance

Group Application for Law Enforcement Officers

"*" indicates required fields

Step 1 of 5

OFFICER'S CONTACT INFORMATION

Requested Effective Date*

Department*

Street Address*

City

State

ZIP

Primary Contact

First and Last Name*

Email Address*

Mobile Phone

Business Phone

Department Email

OFFICER'S OVERALL GENERAL INFORMATION

General Information

Please provide an organizational chart for the department.

New hire application with minimum training requirements.

Confirm internal review procedure for civilian complaints.

Who is responsible for the risk management of the department and what is their job description?

Please upload the documents referenced above.

Max. file size: 50 MB.

LAW ENFORCEMENT (SPREAD OF RISK)

Please list the number of officers in the following departments or divisions broken down by unarmed and armed.

Detective

Detective Amount Armed

Detective Amount Unarmed

Clerical

Clerical Amount Armed

Clerical Amount Unarmed

SWAT

SWAT Amount Armed

SWAT Amount Unarmed

Community Service

Community Service Amount Armed

Community Service Amount Unarmed

Officer

Officer Amount Armed

Officer Amount Unarmed

Highway Patrol

Highway Patrol Amount Armed

Highway Patrol Amount Unarmed

Corrections

Corrections Amount Armed

Corrections Amount Unarmed

Other (Specify)

Other Amount Armed

Other Amount Unarmed

CONTINUING EDUCATION AND TRAINING

What continuing education and training have your officers participated in within the last 5 years?
Please provide a curriculum description.

Education Training

PROFESSIONAL HISTORY

In the last 5 years have any officers experienced any disciplinary action? If yes, please provide details on allegation(s), date of incident(s), result of the investigation, and settlement OR judgment amount.

Professional History

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HILB POLICE SHIELD