R23-132 1 RESOLUTION NO. R23-132
2
3 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA
4 APPROVING THE NEW PROPERTY, CAUSALITY, AND WORKERS'
5 COMPENSATIONS INSURANCE COVERAGE WITH PREFERRED
6 GOVERNMENTAL INSURANCE TRUST (PGIT) AND AUTHORIZE THE
7 CITY MANAGER TO SIGN ALL REQUIRED DOCUMENTS FOR THE TERM
8 OF THE POLICY: OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024;
9 AND PROVIDING AN EFFECTIVE DATE.
10
11 WHEREAS, Florida Municipal Insurance Trust (FMIT) is the City's insurance provider for
12 property, liability and workers' compensation; and
13 WHEREAS, due to an increase of almost 200%, staff directed the Risk Insurance Broker
14 to request a quote from Preferred Governmental Insurance Trust (PGIT); and
15 WHEREAS, staff recommends and the City Commission does hereby approve the new
16 property, causality, and workers' compensations insurance coverage with Preferred
17 Governmental Insurance Trust (PGIT) and authorize the City Manager to sign all required
18 documents for the term of the policy: October 1, 2023 through September 30, 2024.
19 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF
20 BOYNTON BEACH, FLORIDA AS FOLLOWS:
21 Section 1. Each Whereas clause set forth above is true and correct and
22 incorporated herein by this reference.
23 Section 2. The City Commission hereby approves the new property, causality, and
24 workers' compensations insurance coverage with Preferred Governmental Insurance Trust
25 (PGIT) and authorize the City Manager to sign all required documents for the term of the policy:
26 October 1, 2023 through September 30, 2024.
27
S:\CA\RESO\Property And Casualty General Liability Insurance(PGIT)(2023-24)-Reso.Docx
28 Section 3. This Resolution shall become effective immediately upon passage.
29
30 PASSED AND ADOPTED this 14th day of September, 2023.
31 CITY OF BOYNTON BEACH, FLORIDA
32
33 YES NO
34 /
35 Mayor-Ty Penserga
36
37 Vice Mayor-Thomas Turkin
38
39 Commissioner-Angela Cruz
40
41 Commissioner-Woodrow L. Hay
42
43 Commissioner-Aimee Kelley t/
44 SMI9
45 VOTE
46
47
48
49 A T:
5' / '_►
51 - f`1�
52 Mayle D: -sus, MP•, MMCrga
53 City C -rk M., or
54
55 ;�0y NTON,6e\,1 APPROVED AS TO FORM:
56 (Corporate Seal) '< :..'' rE••..."Vo
570...:00)
' 2 l
58 i►-: SEAL • �
i U: RWORATED.'
59 �� NCO 92O David N. Tolces
1
60 Interim City Attorney
t
` ..` FLOR\`'
S:\CA\RESO\Property And Casualty General Liability Insurance(PGIT)(2023-24)-Reso.Docx
Public Risk Underwriters Public Entity Application
ox
455 New
on Muni
Preferred LaakeMMary,8FL 32795-8455 Coverage cTerrm :10/01/2023 to 10/01/2024
Phone:321-832-1450
Fax:321-832-1496
General Member Information
Name:City of Boynton Beach _
Mailing:P.O.Box 310
City/State/Zip:Boynton Beach,FL,334250310
Physical:100 E.Ocean Avenue
City/Stat e/Zip:Boynton Beach,FL,33425
Member Contact Information Additional Member Information
Contact:MorganChaloupka FEIN:59-6000282 NCCI Risk ID:094011477
Title:Risk Manager Population: 80,859
Phone#:561-742-6271 Fax#: County:Palm Beach
Email:ChaloupkaM@bbfl.us Member Type:Municipality
Agency Information Agency Contact Information
Agency:The Gehring Group Contact: Rommi Mitchell
Address:3500 Kyoto Garden Dr Phone#:561-626-6797
City/State/Zip:Palm Beach Gardens FL,33410 Fax#:561-626-6970
Phone#:561-626-6797 Fax#:561-626-6970 Email:rommi.@gehringgroup.com
CERTIFICATION
The undersigned being authorized by and acting on behalf of the applicant and all persons/concerns seeking insurance,has read and understands
this Application,including any appendices and/or supplements,and declares that all statements set forth herein are true,complete and accurate.The
undersigned acknowledges and agrees that the submission and the Trust's receipt of such written report,prior to the inception of the coverage
agreement applied for,is a condition precedent to coverage.
The signing of this Application does not bind the undersigned to purchase the coverage,nor does the review of same bind The Trust to issue a
coverage agreement.This application shall be the basis of the contract,should one be issued.
This Application must be signed by the"Ranking Elected/Appointed Official"of the Entity making the application(e.g.Chair,
President,Superintendent or Executive Director of the Educational Entity)or the Risk Manager(or ranking official)assigned this
function.
SIGNATURE:
TITLE:
DATE: /Z NOTICE TO APPLICANT
For your protection,the following Fraud Warning is required to appear on this application:
FLORIDA FRAUD STATEMENT
Any person who knowingly and with intent to injure,defraud or deceive any insurer,files a statement of claim or an application
containing any false,incomplete or misleading information is guilty of a felony of the third degree.
<�6
Public Entity Application
Preferred Coverage Term:10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Preferred
�NSURANIt i.
Agency: The Gehring Group
Coverages Selected:
Auto Liability Y Auto Physical Damage Y
Boiler&Machinery Y Crime Y
Flood Y Garage Keepers N
General Liability Y Inland Marine Y
Professional Liability V Property Y
Cyber Liability Y
Coverage/Exposure Summary:
Line of Business Exposure/Coverage Applicable/Not Applicable
General Question Application General Information Applicable
General Question Excess WC(Standard Limits are Applicable
$1 M/$1 M/$1 M)
General Question SIR—TPA Information Not Applicable
General Question Stop Loss Not Applicable
Auto Liability Coverage Applicable
Auto Physical Damage Coverage Applicable
Crime Coverage Applicable
Cyber Liability Coverage Applicable
Garage Keepers Coverage Not Applicable
General Liability Coverage Applicable
General Liability Operations:Elder Care/Respite Care Not Applicable
General Liability Operations:Special Events,Fairs or Applicable
Carnivals
General Liability Supervision Abuse Prevention Applicable
(Required)
Professional Liability Law Enforcement Applicable
Professional Liability POUELUEPLI Applicable
Property Coverage Applicable
�
) G � /rte'
Print Dale:8123/2023 Initial '// Date /� (/3 20 MUNIPKG.mt
preferred
d Public ge TrmAp:plicat1io0n/01/2023
0112023 to 10/01/2024
Member Name City of Boynton Beach
Agency: The Gehring Group
APPLICATION GENERAL INFORMATION
General Questions Response
Account CSR: Mitchell,Rommi
Agent Name: Kurt N.Gehring
Tennille Decoste
Primary Member Contact:
If New Primary Contact include name,phone and email address: Tennille Decoste;561-742-6277;
DeCosteT@bbfl.us
Requested Effective Date: 10/01/2023
Requested Termination Date: 10/01/2024
Bid Date(if Applicable,Attach RFP copy):
Need by Date: 08/28/2023
If new business,complete and attach the"Expiring Information"form.
Template can be found under Help section on portal home page
(Submission is not complete without this information).
If with PGIT less than 5 years,complete and attach the"Loss Summary"
form or a"No Known Losses"letter.Form can be found Help section on
portal home page(Submission is not complete without this information).
Member's FEIN 59-6000282
NCCI Risk Id# 094011477
Population 80,859
Have you attached the most recent audited financials/budget? Y
Please Enter Full Detail Description of Operations Municipality with Police&Fire,
and Water Utilities
Installment Schedule:(Only Available for premium>100k,pay plan is agency PKG-Quarterly
bill)
Do you have a Risk Manager?(if yes please provide name and number in Y
comment box) Morgan Chaloupka
Do you have a Human Resource or Personnel Department?(If No please Y
describe handling of this function in comment box)
Number of Full Time Police? 135
Number of Full Time Fire? 164
Number of Full Time all other Personnel? 459
Number of Part Time Police? 6
Number of Part Time Fire? 0
Number of Part Time All Other Personnel including Seasonal personnel? 77
Number of Volunteers Police? 190
Number of Volunteers Fire? 0
Number of Volunteers All Others? 0
Police-Estimated Payroll $21,000,000.00
Fire-Estimated Payroll $20,500,000.00
All Other-Estimated Payroll $38,500,000.00
Print Date:8/23/2023 Initial -D Date 9/) )) 20 MUNIPKG.rpt
ed Public Entity Application
Pref// • Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-PROFESSIONAL LIABILITY-PUBLIC OFFICIALS&EMPLOYMENT PRACTICES
THIS IS AN APPLICATION FOR"CLAIMS MADE AND REPORTED"COVERAGE
POL/EPLI General Questions Response
1 -POL Limit: $5,000,000
2-POL Deductible: $200,000 SIR
3-EPLI Limit: $5,000,000
4-EPLI Deductible: $200,000 SIR
5-POL Retro Date
6-EPLI Retro Date
7-If New Business-Who is your current POL/EPLI carrier? FMIT
8-If new business-What is your current POL/EPLI Limit? $5,000,000
9-If new business-What is your current POL/EPLI Deductible? $200,000 SIR
10-If new business,is your current coverage claims made or occurrence? Occurrence
11-Has your POL/EPLI coverage ever been cancelled or non-renewed? (If yes N
describe answer in comment box)
12-Total Number of Board Members? 5
13-Are Board members Elected?(Y/N)(If no,describe who they are appointed Y
by in comment box)
14-Number of employees who hold professional designations 9
15-Has any bond issue been defeated within the past three years? N
16-If yes,has the proposal been resubmitted or is it expected to be resubmitted? N
17-Has the public entity been in default on the principal or interest on any N
bond?(If yes please provide details in comment box)
18-Do you have a zoning commission?(Y/N) Y
19-Does your legal counsel attend all meetings of the planning and zoning Y
board?
20-Do officials receive training with respect to open meetings and hearing Y
regulations?
21-Do you have a written master plan for economic development?(If Yes,please Y
indicate the 4 digit year it was updated in the comment box)
22-Do you have formally approved land use ordinances that have been reviewed Y
by legal counsel?
23-Do you have a formal procedure to file for a variance to land use statutes? Y
24-Do you have a formal process for application and approval of permits and Y
licenses?
25-Do you have a formal written policy prohibiting elected officials and/or board Y
members from sitting on decisions in which they may have a conflict of interest?
26-If with Preferred less than 5 years,have you had any disputes or claims
involving a wrongful taking,zoning variance or land use right?(If yes,provide
details in comment box).Please note providing details here does not quality as
reporting a claim.
27-If with Preferred less than 5 years,have you had any disputes or claims N
involving the approval of building permits,design,or code enforcement?(If yes,
provide details within comment box.) Please note providing details here does not
qualify as reporting a claim `^l7 9 /
Print Date:8/23/2023 Initial D Date `/2(/c)3 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
28-If with Preferred less than 5 years,have you had any disputes,claims,or N
complaints involving open or closed landfills?(If yes,provide details within the
comment box.)
29-Number of employees reported on IRS Form 1099(no FEIN)and/or who have 1
written employment agreements
30-Total%of involuntary turnover during the last 3 years(Ex.2) 7
31-Total%of voluntary turnover during the last 3 years(Ex.5) 21
32-Average tt of years of employement for all employees(Ex.4) 9
33-Do supervisors receive training in the proper implementation of your policies 1'
and procedures?
34-Is training documented in their personnel file? Y
35-Enter 4 digit year employment manual written or last updated.
36-Is employment manual reviewed by counsel experienced and qualified in Y
employment law?
37-Do policies and procedures comply with state and federal guidelines? Y
38-Is this manual distributed to all employees upon hiring?(If No,please explain Y
why not in the comment box)
39-Do you have a written policy with respect to both sexual and non-sexual Y
harassment?
40-Do you follow a formal written procedure for employee disputes/complaints? Y
41-Are all actions to dismiss or demote employees reviewed in advance by legal Y
counsel?
42-Do you require that due process be served and documented for all Y
proceedings involving dismissal,demotion,or suspension?
43-Are all probationary or disciplinary actions recorded in writing and signed by Y
the employee?
44-Have job descriptions been drafted for regular full-time positions? Y
45-Are you an Equal Opportunity Employer? Y
46-Over the last 5 years has any person made a claim alleging unfair or improper
treatment regarding employee hiring,remuneration,advancement,or termination
of employment?(If yes,explain in the comment box.).Please note providing
details here does not quality as reporting a claim.
47-Answer if with Preferred less than 5 years.Has any claim been made against Y
the entity or any person in their capacity as an official or employee of the entity?
(If yes,explain in the comment box.).Please note providing details here does not
qualify as reporting a claim.
48-Does any official or employee have any knowledge of any fact,circumstance N
or situation which might reasonably be expected to give rise to a claim?(If yes,
explain in the comment box.).Please note providing details here does not qualify
as reporting a claim.
Print Date:8/23/2023 Initial l� Date Q ,( )) 20 MUNIPKG.wt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-CYBER LIABILITY GENERAL QUESTIONS
THIS IS AN APPLICATION FOR CLAIMS MADE AND REPORTED COVERAGE
Cyber Liability Response
1-Cyber Retro Date
2-Do you have anti-virus software installed and enabled on all desktops and Y
servers(excluding database servers)and is it updated on a regular basis?
3-Do you have firewalls installed on all external gateways? Y
4-Do you take regular backups(at least weekly)of all critical data? Y
5-If confidential information is stored on laptops,flash drives and other mobile Y
devices,is the information stored in an encrypted format?
6-Is data"at rest"(servers,etc.)stored in an encrypted format? Y
7-Is multi-factor authentication required for all employees when accessing email Y
through a website or cloud based service?
8-Is multi-factor authentication required for all remote access to the network Y
provided to employees,contractors,and 3rd party service providers?
IN ADDITION TO REMOTE ACCESS,IS MULTI-FACTOR AUTHENTICATION
REQUIRED FOR THE FOLLOWING,INCLUDING ACCESS PROVIDED TO 3RD
PARTY SERVICE PROVIDERS:
9-All internal and remote admin access to directory services Y
10-All internal and remote admin access to network backup environments Y
11-All internal and remote admin access to network infrastructure Y
12-All internal and remote admin access to the organization?s endpoints/servers Y
13-Have you suffered a claim or loss in the last five years,in relation to cyber N
liability or cyber security?If yes,describe:
14-Are you aware of any circumstances or complaints against you in relation to N
data protection or security,PII(Personally Identifiable Information),PHI(Protected
Health Information)or any other actual or potential security violations or breaches
either currently or in the past five years?If so,please describe(Please note
providing details here does not qualify as reporting a claim)
Initial Date C )-- (/))
Print Date:8/23/2023 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
MitMember Name: City of Boynton Beach
Agency: The Gehring Group
PROFESSIONAL LIABILITY-POUEPLI/CYBER
IT IS AGREED THAT IF ANY SUCH FACT,CIRCUMSTANCE OR SITUATION NOT LISTED/DISCLOSED
HEREIN,THEN ANY CLAIM BASED UPON,ARISING OUT OF,OR ATTRIBUTABLE THERETO,IS
EXCLUDED FROM THE COVERAGE BEING APPLIED FOR.
The undersigned,being authorized by and acting on behalf of the applicant and all persons or concerns seeking
coverage,has read and understand this Application,and declares all statements set forth herein are true,complete
accurate.The undersigned further declares and represents that any occurrence or event taking place prior to the
inception of the coverage agreement applied for,which may render inaccurate,untrue or incomplete any statement
made herein will immediately be reported in writing to the Trust.The undersigned acknowledges and agrees that th
submission and the Trust's receipt of such written report,prior to the inception of the coverage agreement applied fi
a condition precedent to coverage.
The signing of this Application does not bind the undersigned to purchase coverage,nor does the review of this
Application bind Preferred to issue a coverage agreement.This Application shall,however,be the basis of the
contract,should a coverage agreement be issued.
Signed Title Date
This Application must be signed by the"Ranking Elected/Appointed Official"of the Entity making the application(e.g.Mayor/Manager/
equivalent Officer)or the Risk Manager(or ranking official)assigned this function.
SIGNATORY ABOVE IS ALSO TO INITIAL EACH AND EVERY PAGE OF THIS APPLICATION.
IMPORTANT NOTICE:SHOULD THE SIGNED APPLICATION DIFFER IN ANY WAY FROM THE APPLICATION
SUBMITTED FOR UNDERWRITING/RATING PURPOSES,THE TERMS,CONDITIONS AND PREMIUM AS
REFLECTED ON SUBJECT TO CHANGE.
Print Date:8/23/2023 Initial �/ Date 20 MUNIPKG.rpl
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-GENERAL QUESTIONS
Excess WC(Standard Limits are VIM/VIM/VIM) Response
1-WC Limit Requested(standard is$1M/$1M/$1M): $1M/$1M/$1M
2-Self Insurance Retention Requested($350,000 Minimum): $500,000.00
3-Is a formal drug free program in operation? Y
4-Is a formal safety program in operation? Y
5-Is there a formal Return to Work?Light Duty program for all operational areas? Y
6-Does employer have a safety committee? Y
7-If Yes,is there management participation? Y
8-Is there a formal review of all workplace accidents? Y
9-Do past,present,or discontinued operations involve storing,treating, N
discharging,applying,disposing,or transporting hazardous materials?If yes,
describe:
10-Any work performed underground or above 15 feet?If yes,describe: Y
Rooftops,tree trimming,
Firefighting
11-Any work performed on docks,barges,vessels,bridges,or over water?If yes, Y
describe: Boardwalks over water;fire
rescue watercraft
12-Are sub-contractors used?If yes,describe: Y
13-Are Work Comp COI's required for sub-contractors/vendors? Y
14-Do employees travel out of state?If yes,describe: N
15-Do you lease employees to or from other employers?If yes,describe: N
16-Any group transportation provided?If yes,describe: Y
17-Are physicals required after offers of employment are made?If yes,list which
departments or positions require physicals. Police&Firefigters
18-Are there any occupational disease exposures involved in the operation Y
including asbestos,silica,dust,hazardous chemicals,radiation,communicable Police,Firefigters,and water
disease or any other occupational disease exposure?If Yes,describe. utilities
19-Is there any owned,leased or chartered aircraft?If yes,complete aviation N
supplemental application.
20-Is there any owned,leased or chartered watercraft?If yes,describe operation. Y
Public works;Parks&Rec;
Firefigters,and water utilities
21-Any employees who may be subject to the Longshore and Harbor Workers' N
Compensation Act,Jones Act or Federal Employer's Liability Act?If yes,
describe.
22-Do operations include electric utility?If yes,describe: N
23-Any power generation? N
24-Any power distribution? N
25-#Lineman
26- Amount of payroll associated with lineman:
27-Do operations include gas utility?If yes,describe. N
28-Do operations include a penal facility?If
yes,describe. N
Print Date:8/23/2023 Initial 'J'/ Date 9(di /c)$ 20 MUNIPKG.rpt
Public Entity Application
Pr/.
erredCoverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
29-Do operations include amusement park or similar facility?If yes,describe. N
30-Do you provide in house medical for first aid injuries?If yes,who provides N
treatment?
Print Date:8/2312023 Initial f 1l) Date /JO) 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
® Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-Auto Liability
Coverage Response
1-AL Limit: $2,000,000
2-AL Territory: 1T-Atlantic Coast(1T)
3-AL Deductible: $100,000 SIR
4-Medical Payment limit: $0
5-Uninsured/Underinsured motorist limit(Maximum$100,000): $0
6-Hired and Non-Owned Liability?(Y/N) Y
7-If symbol 10 for AL is required,provide definition:
8-How often do you inspect vehicles for safety hazards? Daily
9-Are safety inspection records maintained? Y
10-Are vehicles assigned to specific drivers with back up drivers? Y
11-Do you own any 15 Passenger Vans with Model Year 2006 or older?(If yes, N
provide Member's policy/procedure with regards to how many passengers are
transported in each van,seatbelts,other safety procedures,etc.in comments
box)
12-Are 15 passenger vans used for passenger transportation? Y
13-Do you own/operate Autonomous Vehicles?If so Autonomous Vehicle No
Supplemental Application is required.:
PLEASE ENTER 4 DIGIT YEAR FOR DATE WRITTEN,LAST UPDATED OR
"NONE"for the next 5 questions
14-Fleet Management Safety Manual: 2019
15-Driver Training Program: 2014
16-MVR Criteria: N/A
17-Formal Written Accident Reporting Procedure: 2011
18-Employee Disciplinary Program for Driver Safety 2021
Pent Date:8/23/2023 Initial '/ Date qO I 1 7 20 MUNIPKG.rpt
Public Entity Application
Pref.err /� Coverage Term: 10/01/2023 to 10/01/2024
® INr Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-Auto Physical Damage
Coverage Response
1-Collision Auto Symbol: 2
2-Comprehensive Auto Symbol: 2
3-Symbol 10 definition,if required:
4-Hired Physical Damage Limit(0/35K/50K/75K/100K): $100,000
5-Hired Physical Damage Deductible: $10,000.00
Initial Date 9/4)(/)1Print Dale:812312023 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-CRIME
Coverage Response
1-Employee Dishonesty Blanket Limit(faithful performance included): $50,000
2-Employee Dishonesty Deductible $1,000
3-Theft,Disappearance or Destruction Limit $50,000
4-Theft,Disappearance or Destruction Deductible $1,000
5-Computer Fraud Limit $50,000
6-Computer Fraud Deductible $1,000
7-Forgery or Alteration Limit $50,000
8-Forgery or Alteration Deductible $1,000
9-Does the applicant check for past criminal records(theft of money and Y
securities,robbery,etc.)on rateable employees?
10-How frequently are audits performed?(weekly,monthly,quarterly,annually) Annually
11-Who performs the audit? CPA
12-Is countersignature of checks required? Y
13-Are your bank accounts reconciled by someone not authorized to deposit or Y
withdraw?
14-Number of employees handling money(accountants,bookkeepers,cashiers, 34
check signers,etc.):
15-Number of messengers: 0
16-Number of guards accompanying messenger: 0
17-Is banking done by your internal staff or by other outside professionals? Internal Staff
Print Date:8/23/2023 Initial DO/ Date 1.? / `'/� 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-General Liability
Coverage Response
1-GL Occurrence Limit $5,000,000
2-GL Deductible $200,000 SIR
3-Employee Benefits Occurrence Limit $5,000,000
4-Medical Expense Limit(Max$5,000) $0
5-Total number of Housing Authority units
6-If Housing Authority,please give number of section 8 units(including USDA
units)
7-Number of hotel units owned/operated by member
8-Do you require all contractors&vendors with whom you do business to Y
provide a contractual hold harmless and certificate of Insurance.
9-Do you require groups using your facilities to provide a contractual hold Y
harmless and Certificate of Insurance?
10-Do you require groups using your facilities to make you an additional Y
insured on their insurance policy?
11-Do you have an ADA coordinator?If so please provide name.: Stephanie Soplop
12-If you are a special district,are you responsible for sidewalk maintenance?
CHECK YES/NO FOR EACH OF THE FOLLOWING EXPOSURES
13-Athletic Fields&Activities Y
14-Airports/Aircraft(Coverage limited to Premises Liability Only) N
15-Bleachers/Auditoriums/Stadiums Y
16-Do you sponsor/operate Children/Youth Programs? Y
17-Do you sponsor/operate Sr.Adult Program? Y
18-Do you sponsor/operate programs for emotionally/mentally challenged N
individuals?
19-Electric Power Distribution(Power Generation excluded) N
20-EMT's/Paramedics(Inc!Fire Dept&Other 1st Responders) Y
21-Exhibition/Convention Center N
22-Gas Utility Distribution(Generation Excluded) N
23-Golf Course N
24-Hospitals,Nursing Homes,Medical Facilities(Coverage limited to N
Premises Liability only,Medical Malpractice excluded)
25-Law Enforcement(See Law Enforcement section for coverage questions) Y
26-Marinas(Premises Liability only excludes Marina Operators Liability) N
27-Detention Facilities(See Law Enforcement section for coverage questions) N
28-Restaurants/Snack Bars/Food Beverage Carts N
29-Skate Parks Y
30-Swimming Pools/Water Parks/Splash Parks Y
31-Wastewater Treatment Y
32-Water Utility Y
33-Watercraft(Coverage limited to craft less than 52ft excludes paying Y
passengers)
Print Date:8/23/2023 Initial '✓ Date - 20 MUNIPKG.rpt
1�
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
34-Wharves/Piers/Docks(Excluding Marina Ops Liability) Y
35-Drones(if yes,and you are requesting coverage complete the Unmanned Y
Aircraft/Drone supplemental application found in the pool forms and documents)
COVERAGE INFORMATION-General Liability
Operations:Elder Carel Respite Care Response
1-Number of Elder Care/Respite Care locations
2-Ratio of clients to care providers
COVERAGE INFORMATION-General Liability
Operations:Special Events,Fairs,or Carnivals Response
1-If you have fireworks displays,how many a year do you have? 1
2-Do you contract out the fireworks display to a licensed Pyrotechnician? Y
Print Date:8/23/2023 Initial 20 MUNIPKG.wt
C�IJ
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-General Liability
Supervision Abuse Prevention(Required) Response
1-Who in the Entity has been designated to handle claims(include name, Morgan Chaloupka;100 E.Ocean
address,telephone number and email)? Ave.,Boynton Beach,FL 33425;
561-742-6271;
ChaloupkaM@bbfl.us
2-With respect to Claims Incidents,etc.,do you have a written procedure for Y
obtaining information?
ENTER YES/NO FOR ALL OPERATIONS LISTED BELOW
3-Camps(Residential):(Yes/No) N
4-Camps with overnight stays:(Yes/No) N
5-Daycare Centers/Nursery Schools-Children or Adult Care:(Yes/No) N
6-Juvenile Detention Centers:(Yes/No) N
7-Medical Services and Professionals-Doctors,Psychiatrists,Visiting Nurse N
Services:(Yes/No)
8-Mental Institutions:(Yes/No) N
9-Orphans or Foster Homes,including Social Service Agencies responsible N
for the Foster Home evaluation and/or placement:(Yes/No)
10-Religious/Clergy/Church Organizations N
11-Schools-public or private elementary,junior high or high school:(Yes/No) N
12-Social Service Counselors-Social Workers,Psychologists:(Yes/No) N
13-Special Needs Educational Facilities:(Yes/No) N
14-Substance Abuse Facilities with ovemight stays:(Yes/No) N
15-Substance Abuse Facilities without overnight stays:(Yes/No) N
16-Youth Organizations(Sports,Scouts,YMCA/YWCA,Big Brothers/Sisters, N
etc):(Yes/No)-If yes please specify in Comment field
17-Is there a Sexual Abuse Prevention Program in effect? Y
18-Has a written policy been established clearly expressing management's Y
commitment to sexual abuse prevention?
19-Have written procedures encompassing rules,a code of conduct and Y
disciplinary measures been established for all staff and/or volunteers,which
clearly define the policy and consequences of non-adherence?
20-Has a mechanism been developed to ensure that sexual abuse prevention Y
policies and procedures are implemented and enforced throughout the
organization?
21-Is there a Sexual Abuse Prevention Coordinator that reports to a member N
of management?
22-Are management/staff trained in policies and procedures relating to the Y
Sexual Abuse Prevention Program?
23-Do policies and procedures include an incident reporting and follow-up Y
mechanism?
24-Are standard applications used for all prospective employees or Y
volunteers?
25-Is there a minimum of two background checks for prospective employees Y
with documentation maintained in file?
10.
Print Date:8/23/2023 Initial D9 Date r 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
26-Do background checks include checks with"Sex Offender Hot-lines", Y
State Police,State Department of Social Services,or similar public agencies?
(where applicable)
27-In the past five years have any employees or officers been terminated for N
cause related to sexually abusive behavior?
28-Are records maintained documenting adherence t0 all applicable policies Y
and procedures,e.g.,hiring and screening,code of conduct,training,incident
and follow-up procedures?
29-Are you aware of any circumstance that may result in a sexual abuse N
claim?If Yes,explain in the comment box.(Please note providing details here
does not qualify as reporting a claim)
30-Have any members of the staff been transferred because of allegations of N
sexual abuse?
Print Date:8/23/2023 Initial Date • - 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-Professional Liability
Law Enforcement Response
1-Law Liability Limit: $5,000,000
2-Law Liability Deductible: $200,000 SIR
3-Please provide the title of person responsible for Law Enforcement Joe DeGiulio
Operations: _
4-Please provide the contact information for person responsible for Law 561-742-6101;degiulioj@bbfl.us
Enforcement Operations:
5-Are you a party to any mutual aid agreements?(Please list or answer Enforcement Agencies Combined
"None".) Operational Assistance and
Voluntary
6-Do you provide contracted services to any other entities?(Please list or No
answer"No".)
PLEASE COMPLETE THE FOLLOWING BY ENTERING NUMBER OF
EMPLOYEES,ACCOUNT FOR EACH EMPLOYEE ONLY ONCE IN THEIR
PRIMARY CLASSIFICATION.
7-Full-time with arrest powers 135
8-Part-time with arrest powers 6
9-Full-time jailers 0
10-Part-time jailers 0
11-Volunteers w/arrest powers 0
12-Volunteer Jailers w/arrest powers 0
13-Volunteers without arrest powers 190
14-All other police personnel 59
15-Canines 3
16-Horses 0
17-Do you handle your own dispatching? Y
18-Do you dispatch for any other entities? N
19-Do your Law Enforcement dispatchers also dispatch for emergency Y
medical and fire fighting services?
20-Are all incoming calls recorded? Y
21-Average#of months tapes are maintained(Ex.12) 3
22-How many hours of training do dispatchers receive? 480
23-Do you participate in any internship or ride-along programs? Yes
24-Do you own,operate,or maintain any fixed or rotary wing aircraft? No
25-Do you own,operate,or maintain any watercraft? Yes
26-What is the current annual operating budget for the law enforcement $21,771,219.00
agency?
WHICH OF THE FOLLOWING ARE INCLUDED IN YOUR SELECTION
PROCESS PRIOR TO EMPLOYMENT:
27-Written Exam? Y
28-Psychological Exam? Y
29-Background and employment investigation? Y
Print Date:8/23/2023 Initial Date =>jr?,.3 20 MUNIPKG.rpt
ZD
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
30-Do all law enforcement officers meet your state's minimum standards for Y
training and receive certification?
31-Is all employee training,both past and present,documented and kept on Y
file? _
32-Does your agency have a Field Training Program for new employees? Y
33-What is the Average Salary of your current full-time sworn officers? $92,286.00
34-What is the Average#of Years of Service of your current full-time sworn 11
officers?
ARE OFFICERS REQUIRED TO COMPLETE TRAINING IN THE USE OF:
35-Baton/PR-24/ASP? V
36-Chemical Irritants? V
37-Electronic Control Device(Stun gun or Taser)? V
38-Carotid control hold? N
39-Other,please describe.
40-Are all officers required to complete a Defensive Driving Program? V
41-Do all officers receive training in simulated or actual high speed pursuit? V
42-Do all officers receive training in First Aid? V
43-Do all officers receive training in CPR? Y
44-Do all officers receive training in the use of Defibrillators? V
45-Do you maintain a formal Policies and Procedures Manual V
46-Do all employees receive their own copy? Y
47-Enter 4 digit year manual was last updated? 2021
48-Is your manual regularly reviewed by competent legal counsel? Y
DO YOU HAVE FORMAL WRITTEN POLICIES AND PROCEDURES
PERTAINING TO THE FOLLOWING SUBJECTS:(Y/N)
49-Use of deadly force? Y
50-Use of non-deadly force? Y
51-Vehicle high-speed pursuit? V
52-Domestic Violence? Y
53-Search and seizure? Y
54-Intoxicated arrestees? V
55-Communicable diseases? Y
56-Employee moonlighting? V
57-Has any claim been made or suit filed against the entity or any person in
their capacity as an official or employee of the entity in the last five years?If
with Preferred less than 5 years,please describe with details in the comment
field including status.Please note providing details here does not qualify as
reporting a claim.
58-Does any official or employee have any knowledge of any fact, N
circumstance or situation which might reasonably be expected to give rise to a
claim?If yes,please provide summary with details in the comment.Please
note providing details here does not qualify as reporting a claim.
59-Has the Law Enforcement coverage been cancelled or non-renewed within N
the last five years?If Yes please descrriiibe{\int^the
\ccomment field.
Print Date:8(2312023 Initial Initial Date 20 MUNIPKG.rpl
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
60-Do you have a detention facility of any kind?If no,you may skip the N
remaining questions and go to the next coverage section.
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR FACILITY?
61-Temporary holding facility(under 8 hours-no overnight)
62-Temporary holding cell(from 8 to 24 hours)
63-Jail-for persons serving time,awaiting trial or transfer
64-Enter 4 digit year facility was built(Ex.2000)
65-Enter 4 digit year facility was last renovated(Ex.2011)
66-What is the state certified capacity?
67-What is the average daily inmate population?
DOES YOUR FACILITY HOUSE HAVE THE FOLLOWING(Y/N)
68-Adult prisoners only?
69-Males and females?
70-Violent and non-violent prisoners?
IS YOUR FACILITY EQUIPPED WITH SURVEILLANCE SYSTEMS TO
MONITOR ACTIVITY IN THE FOLLOWING AREAS?(Y/N)
71-Individual detention cells?
72-Secured common areas?
73-Booking area?
74-Sally port?
WHEN WAS YOUR FACILITY LAST INSPECTED BY THE FOLLOWING?
ENTER 4 DIGIT YEAR.
75-State Corrections Officials?
76-Fire Inspectors?
77-Department of Health?
78-Do you have standard fire protection systems including smoke detectors
and fire alarms?
79-How many hours of training are required prior to employment as a guard or
jailer?
80-Do dispatchers serve as jailers?
81-If so,do they receive the same training?
82-Do you employ or contract with Doctor(s)?
83-Do you employ or contract with Nurse(s)?
84-Do you employ or contract with Dentist(s)?
85-Do you employ or contract with Psychologist(s)?
86-Do each of the above maintain their own professional errors and omissions
liability coverage?
87-Has anyone ever successfully committed suicide in your facility?If yes,
please place explanation in comment box.
88-How many attempted suicides have there been in your facility in the last
three years?
89-Has your facility ever been subject to a court order or Consent Decree?
90-What is the average occupancy percentage of your facility? />
Pnnt Date:8/23/2023 Initial Dip Date q/✓ /c)
((( 20 MUNIPKG.rpt
QD
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
DO YOU HAVE FORMAL WRITTEN DETENTION CENTER POLICIES AND
PROCEDURES FOR:
91-Intake screening and classification?
92-Medical screening?
93-Suicide detection and prevention?
94-Periodic walk-through of the facility?
95-Administration and control of medication?
96-Use of force?
97-Emergency evacuation?
98-Communicable diseases?
99-Enter 4 digit year your manual was last updated(Ex.2015)
100-Is your manual reviewed by legal counsel?
Print Date:8/23/2023 Initial (�0 Date i) 20 MUNIPKG.rpt
Public Entity Application
Preferred Coverage Term: 10/01/2023 to 10/01/2024
Member Name: City of Boynton Beach
Agency: The Gehring Group
COVERAGE INFORMATION-Property
Coverage Response
1-ISO Protection Class: 3
2-AOP Property Deductible: $25,000
3-Excess Flood Limit(primary for zones other than A&V)-Maximum Limit $5,000,000
$5,000,000
4-Earth movement Limit-Maximum Limit$5,000,000 $5,000,000
5-Equipment Breakdown Coverage requested(Y/N) Y
6-Do any of the buildings have unrepaired damage from a recent loss?If so, N
please describe the extent of the damage and location.
7-Date of last property valuation:(4 digit year) 2023
8-If new business,have you attached a copy of your most recent appraisal? Y
9-Does the member own any structures not listed on the Property Application N
Schedule of Locations?If yes,provide description in the comment box.
10-Are these structures insured with another carrier? N
Print Dale:8/23/2023 Initial Date ,)/ `�� 20 MUNIPKG.mt
Submission Checklist
For selected coverages,have you attached
New Business
Expiring Coverage Information-see Template in Portal Documents.Include target premium.
If requesting property coverage,provide a copy of the most recent appraisal.
All Coverages
5 years of currently valued loss runs(if with Preferred less than 5 years)except XS WC,see section below
Details on any claims in excess of$50,000
Premium Loss Summary(if with Preferred less than 5 years)
Most recent audited financial or link to website that we can get it from
Liability Coverage
Policies&procedures(including incident response)related to your Sexual Abuse Prevention Program
List of all Sexual Abuse claims with a Total Incurred Amount in excess of$10,000
Workers'Compensation-1st Dollar Standalone application
Employee Concentration Form
Payroll Schedule by Class Code
Aviation supplemental if aviation class code requested
Worker's Compensation-SIR/Excess coverage included in Package application
10 years of currently valued loss runs(if with Preferred less than 5 years)
Employee Concentration Form
Payroll Schedule by Class Code
Aviation Supplemental if aviation class code requested
Employment Practices Liability Employee
Handbook
Educators Legal Liability
Student Handbook
Automobile Liability
15 Passengers Vans older than 2006-Copy of safety policy/procedures for Van usage
Property/Automobile/Inland Marine
Schedules in the Preferred template
-End of Application-
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