HomeMy Public PortalAbout074-2016 - Police - Testing for Public Safety - Interview ProcessPROFESSIONAL CONSULTING SERVICES AGREEMENT
THIS AGREEMENT made and entered into this / `� day of / , 2016, and referred to
as Contract No. 74-2016, by and between the City of Richmond, ndiana, a municipal corporation
acting by and through its Board of Public Works and Safety (hereinafter referred to as the "City")
and Testing for Public Safety, LLC DBA The Institute for Public Safety Personnel, 5948 N. College
Avenue, Indianapolis, Indiana, 46220-2554 (hereinafter referred to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor to provide consulting and testing services in connection with the
Richmond Police Department performance review process. Specifically, Contractor shall provide
services including, but not limited to, providing training materials, development of written test for
promotions, oral interview questions, and scoring of composite materials used to develop the rank
order of candidates testing for Investigator, Sergeant, Lieutenant, or Captain. Contractor shall
perform all services described on Contractor's proposed Agreement "Exhibit A" consisting of three
(3) pages, which exhibit is dated June 23, 2016, and attached hereto and made a part hereof.
Should any provisions, terms, or conditions contained in any of the documents attached hereto as
Exhibits, or in any of the documents incorporated by reference herein, conflict with any of the
provisions, terms, or conditions of this Agreement, this Agreement shall be controlling.
Contractor shall perform all work herein in a timely manner, conforming to all applicable
professional standards.
The Contractor shall furnish all labor, material, equipment, and services necessary for the proper
completion of all work specified.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance;
2. The City is in receipt of any required affidavit signed by Contractor in
accordance with Indiana Code 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of the
City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the
work.
Contract No. 74-2016
Page 1 of 6
SECTION III. COMPENSATION
City shall pay Contractor a sum estimated not to exceed One Thousand Four Hundred Dollars
($1,400.00) for the complete and satisfactory performance of all work described on "Exhibit A".
SECTION IV. TERM OF AGREEMENT
This Agreement shall be effective as of June 23, 2016, and shall continue in effect until June 22,
2017.
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part,
for cause, at any time by giving at least five (5) working days written notice specifying the effective
date and the reasons for termination which shall include but not be limited to the following:
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement
is made; or
e. unavailability of sufficient funds to make payment on this Agreement.
In the event of such termination, the City shall be required to make payment for all work performed
prior to the date this Agreement is terminated, but shall be relieved of any other responsibility herein.
This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by
setting forth the reasons for such termination, the effective date, and in the case of partial
termination, the portion to be terminated.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or
property or any other claims which may arise from the Contractor's conduct or performance of this
Agreement, either intentionally or negligently; provided, however, that nothing contained in this
Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers,
agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter
maintain such insurance as will protect it from the claims set forth below which may arise out of or
result from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or
by anyone for whose acts the Contractor may be held responsible.
Page 2 of 6
Coverage Limits
A. Worker's Compensation & Statutory
Disability Requirements
B. Employer's Liability $100,000
C. Comprehensive General Liability
Section 1. Bodily Injury $1,000,000 each occurrence
$2,000,000 aggregate
Section 2. Property Damage $1,000,000 each occurrence
D. Comprehensive Auto Liability
Section 1. Bodily Injury $1,000,000 each person
$1,000,000 each occurrence
Section 2. Property Damage $1,000,000 each occurrence
E. Comprehensive Umbrella Liability $1,000,000 each occurrence
$2,000,000 each aggregate
F. Malpractice/Errors & Omissions Insurance $1,000,000 each occurrence
$1,000,000 each aggregate
SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility
status of all newly hired employees of the contractor through the Indiana E-Verify program.
Contractor is not required to verify the work eligibility status of all newly hired employees of the
contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists.
Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit
affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC
22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to
remedy the violation not later than thirty (30) days after the City notifies the Contractor of the
Page 3 of 6
violation. If Contractor fails to remedy the violation within the thirty (30) day period provided
above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement
will be terminated. If the City determines that terminating this Agreement would be detrimental to
the public interest or public property, the City may allow this Agreement to remain in effect until the
City procures a new contractor. If this Agreement is terminated under this section, then pursuant to
IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages.
SECTION VIII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in
investment activities in Iran. In the event City determines during the course of this Agreement that
this certification is no longer valid, City shall notify Contractor in writing of said determination and
shall give contractor ninety (90) days within which to respond to the written notice. In the event
Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran
within ninety (90) days after the written notice is given to the Contractor, the City may proceed with
any remedies it may have pursuant to IC 5-22-16.5. In the event the City determines during the
course of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves the right to consider
the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of
the ninety (90) day period set forth above.
SECTION IX. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on
behalf of Contractor or any sub -contractor shall not discriminate against any employee or
applicant for employment to be employed in the performance of this Agreement, with respect
to hire, tenure, terms, conditions or privileges of employment or any matter directly or
indirectly related to employment, because of race, religion, color, sex, disability, national
origin, or ancestry.
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
l . That in the hiring of employees for the performance of work under this Agreement of
any subcontract hereunder, Contractor, any subcontractor, or any person acting on
behalf of Contractor or any sub -contractor, shall not discriminate by reason of race,
religion, color, sex, national origin or ancestry against any citizen of the State of
Indiana who is qualified and available to perform the work to which the employment
relates;
2. That Contractor, any sub -contractor, or any person action on behalf of Contractor or
any sub -contractor shall in no manner discriminate against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
That there may be deducted from the amount payable to Contractor by the City under
this Agreement, a penalty of five dollars ($5.00) for each person for each calendar
day during which such person was discriminated against or intimidated in violation of
the provisions of the Agreement; and
Page 4 of 6
4. That this Agreement may be canceled or terminated by the City and all money due or
to become due hereunder may be forfeited, for a second or any subsequent violation
of the terms or conditions of this section of the Agreement.
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION X. RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents
of the same from all liability for negligence which may arise in the course of Contractor's
performance of its obligations pursuant to this Agreement.
SECTION XI. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of its
rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assignment, without the prior written consent of the other party, shall be null and void.
This Agreement shall be controlled by and interpreted according to Indiana law and shall be binding
upon the parties, their successors and assigns. This document constitutes the entire Agreement
between the parties, although it may be altered or amended in whole or in part at any time by filing
with the Agreement a written instrument setting forth such changes signed by both parties. By
executing this Agreement the parties agree that this document supersedes any previous discussion,
negotiation, or conversation relating to the subject matter contained herein.
This Agreement may be simultaneously executed in several counterparts, each of which shall be an
original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising
out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or
mediation shall be required prior to the commencement of legal proceedings in said Courts. By
executing this Agreement, Contractor is estopped from bringing suit or any other action in any
alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the
Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to
bring such suit in front of other tribunals or in other venues.
Any person executing this Contract in a representative capacity hereby warrants that he/she has been
duly authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages or
remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
Page 5 of 6
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or
burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the
provisions of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the
day and year first written above, although signatures may be affixed on different dates.
"CITY"
THE CITY OF RICHMOND,
INDIANA by and through its
Board of Public Works and Safety
y4a/)
Vicki Robinson, President
Richard Foore, Member
By:
Anthony oster, II, Member
Date:
APPROVEI
Date:
"CONTRACTOR"
TESTING FOR PUBLIC SAFETY, LLC,
DBA THE INSTITUTE FOR PUBLIC
SAFETY PERSONNEL
5948 N. College Avenue
Indianapolis, Indiana, 46220-2554
By: b �&�
74rn 4 -)- -m�rso�-t
Printed:
Title:
Date:
Page 6 of 6
AGREEMENT
THIS AGREEMENT for professional services, dated this 23,d of June 2016, by and between Testing for
Public Safety, LLC - doing business as The Institute for Public Safety Personnel (hereinafter "TPS") and the
Richmond Police Department (hereinafter "Public Employer"):
A. Basic Services
1. Effective June 23, 2016, and continuing through June 22, 2017, TPS shall, pursuant to the terms
and conditions set forth herein, provide the Public Employer with the professional consulting services set forth in
Exhibit A attached hereto and made a part hereof.
B. Operation
1. The relationship between TPS and the Public Employer shall be that of an independent contractor
providing professional services.
2. TPS shall furnish, or make contact with other individuals or entities to furnish such professional,
technical, or clerical services as are needed for the administration of the TPS programs. TPS shall provide for all
salaries and the employer's share of social security, worker's compensation, and all other taxes imposed on an
employer with reference to any personnel employed by TPS in relation to the performance of the terms of this
Agreement.
3. All test materials developed and administered by TPS are the property of TPS. This Agreement
provides for a one-time usage of test materials specifically developed for the purpose of executing this Agreement.
Public Employer agrees to respect the copyright of all TPS materials and agrees not to duplicate said materials
without the expressed written consent of the Director of TPS.
4. All records kept by TPS concerning the designated programs herein shall be the property of TPS
provided that the Public Employer shall have the right to access and review the information contained in such
records.
5. In the event an applicant or incumbent requires a reasonable accommodation in the administration
of any test by TPS, the Public Employer agrees to pay a reasonable additional fee therefore.
6. The total cost to the Public Employer for services of TPS as provided for in this Agreement shall
be in the amount set forth in Exhibit A. Such amount shall be remitted to TPS within thirty (30) days after
completion of the agreed services. The services rendered by TPS under this Agreement shall be considered as
"professional services." Upon request, TPS shall provide a fully itemized statement concerning the services
rendered under this Agreement.
C. Additional Services
l . The Public Employer may, from time to time, require changes in the scope of the services of TPS
to be performed under this Agreement. Such changes, including any increases or decreases in the amount of
compensation to TPS which are mutually agreed upon by the parties hereto, and approved by all other necessary and
proper authorities, shall be incorporated in written amendments to this Agreement.
2. TPS further agrees that its personnel will appear, if necessary, to testify on behalf of the Public
Employer with regard to any legal challenge involving TPS programs, and that TPS personnel shall make such
appearance without compensation other than out-of-pocket expenses.
D. Miscellaneous
1. If TPS fails to fulfill in a timely and proper manner the obligations pursuant to this Agreement, the
Public Employer shall thereupon have the right to terminate this Agreement by giving written notice to TPS at least
thirty (30) days prior to the effective date of such termination. In the event of termination, neither party hereto shall
be relieved of liability to the other for damages sustained by virtue of any breach of this Agreement, and the Public
Employer may withhold payment to TPS for the purpose of setoff until such time as the exact amount of damages
due the Public Employer can be determined.
2. If the Public Employer shall fail to fulfill in a timely and proper manner the obligations pursuant
to this Agreement, TPS shall thereupon have the right to terminate this Agreement. Said notice shall be given to the
Public Employer at least thirty (30) days prior to the effective date of such termination. In the event of termination,
neither party hereto shall be relieved of liability to the other for damages sustained by virtue of any breach of this
Agreement.
3. TPS shall indemnify and hold harmless the Public Employer from any and all loss, damage, injury
or liability caused by the negligence of TPS or its employees or agents in performing its obligations provided in this
Agreement.
4. TPS shall not be held liable and the Public Employer shall hold TPS harmless from any and all
loss, damage, injury or liability caused by the negligence of the Public Employer or its employees or agents in
disregarding or ignoring any professional opinion, diagnosis or recommendation of TPS or its employees or agents
while TPS is performing its obligations provided in this Agreement.
5. TPS certifies and warrants that it has the capacity to perform the services as required by the Public
Employer with high professional quality, ability and expertise and further certifies and warrants that it has the
capacity and authority to enter into this Agreement.
6. TPS and its employees, agents and representatives, in the performance of this Agreement, agree
not to discriminate against any employee or applicant for employment with respect to his or her tenure, terms,
conditions, or privileges of employment, or any matter directly or indirectly related to employment, because of race,
color, sex, religion, national origin, ancestry, disability, or military veteran status.
7. This Agreement shall be binding upon and shall inure to the benefit of TPS, its partners,
successors, assigns, legal and personal, representatives, and administrators.
8. At the expiration of the initial term hereof, or upon earlier termination of this Agreement pursuant
to Section D, 1, the parties shall review the compensation paid by Public Employer and the services rendered by
TPS through the date of such termination to determine whether Public Employer is entitled to any reimbursement or
whether TPS is entitled to additional compensation, and any necessary adjustments shall be made.
9. Nothing herein shall be construed as creating any personal liability on the part of any officer,
director, agent, or employee of any public body which may be a party hereto.
10. This Agreement represents the entire understanding between and among the parties hereto. This
Agreement may not be changed, altered, or amended; modification of this Agreement must be in writing, executed
by the parties hereto, refer to this Agreement by date, and must be executed on a form entitled "Supplemental
Agreement" approved by all parties hereto.
IVTesting for Public Safety, LLC
dba IPSP
Process Steps
Costs
Richmond Police Department
Applicant Oral Interview Testing
Exhibit A
I. Identify potential structured oral interview questions based on knowledge, skills and abilities
(KSAs) identified in transportability study.
II. Meet with structured oral interview rating board to finalize selection of structured oral interview
questions, to review associated anchors and to train board on interview procedures.
III. Provide TPS monitor for first day, sufficient materials and supplies to administer structured oral
interviews to applicants.
IV. Score results of structured oral interview, combine with aptitude test results, and produce rank
order list (within 10 working days of administration).
V. Provide department with phone and written consultation as to use of test results for selection
decisions.
A. $1,400.00 for first 20 applicants. Cost includes training of interview board and (1) interview
monitor for up to (1) day.
B. $25.00 for each additional applicant over 20.
C. $350.00/day for additional monitoring unless a monitor is provided by department.
IN WITNESS WHEREOF, the parties have executed this Agreement.
TESTING FOR PUBLIC SAFETY, LLC
By:
RICHMOND POLICE DEPARTMENT _
EXHIBIT PAGE _OF
By:
Date: Da
S
WEST BEND
A MUTUAL INSURANCE COMPANY -
West Bend Mutual Insurance Company
1900 S. 18th Ave. I West Bend, WI 53095
Customer Number: 1000036800
Policy Number: A092932 00
Named Insured and Address:
Testing For Public Safety, LLC
5948 N College Ave
Indianapolis, IN 46220
New Business
Commercial Lines Policy Declaration
Policy Period: 12/01/2015 to 12/01/2016
at 12:01 AM Standard Time at Your Mailing Address Shown Below
Agency Name and Address: 13160
CENTRAL INSURANCE ASSOC INC
70 EAST 91ST STREET, SUITE 200
INDIANAPOLIS, IN 46240-7622
317-846-4622
In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the
insurance as stated in this policy.
This policy consists of the following coverage parts for which a premium is indicated. This premium may be subject to
adjustment.
Coverage Part
SMARTbusinessTM Coverage
Business Auto Coverage
Total Premium:
Total Including Taxes, Fees and Surcharges:
This is not a bill. A billing invoice will be sent separately.
See attached schedule for forms applicable to all covefAge parts.
Countersignature
(Authorized Representative)
Premium
$1,273.00
$166.00
$1,439.00
$1,439.00
Date *I�
DCP 01 04 14 12/08/2015 10:02:55
WEST BEND
A MUTUAL INSURANCE COMPANY•
West Bend Mutual Insurance Company
1900 S. 18th Ave. I West Bend, WI 53095 New Business
Commercial Lines Policy Declarations
Customer Number: 1000036800 Policy Period: 12/01/2015 to 12/01/2016
Policy Number: A092932 00 at 12:01 AM Standard Time at Your Mailing Address Shown Below
Named Insured and Address: Agency Name and Address: 13160
Testing For Public Safety, LLC CENTRAL INSURANCE ASSOC INC
5948 N College Ave 70 EAST 91 ST STREET, SUITE 200
Indianapolis, IN 46220 INDIANAPOLIS, IN 46240-7622
317-846-4622
Forms Schedule
Number
Edition
Description
IL0017Z
1198
COMMON POLICY CONDITIONS
IL0021
0908
NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM)
WB214A
0309
MEMBERSHIP AND VOTING NOTICE
WB660
0109
TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US
IL0117Z
1210
INDIANA CHANGES - WORKERS' COMPENSATION EXCLUSION
IL0156Z
0907
INDIANA CHANGES - CONCEALMENT, MISREPRESENTATION OR FRAUD
IL0158Y
0908
INDIANA CHANGES
IL0272Z
0907
INDIANA CHANGES - CANCELLATION AND NONRENEWAL
BP0523
0115
CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
IL0985Z
0115
DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT
DCP 04 04 14 - 12/0$/2015 10:02:55
WEST BEND
A MUTUAL INSURANCE COMPANY'
West Bend Mutual Insurance Company
1900 S. 18th Ave. I West Bend, WI 53095 New Business
Standard Workers Compensation and Employers Liability Policy
NCCI Carrier Code: 17124 Customer Number: 1000036800 Policy Number: A092949 00
1. Named Insured and Address: Agency Name and Address: 13160
Testing For Public Safety, LLC CENTRAL INSURANCE ASSOC INC
DBA IPSP 70 EAST 91ST STREET, SUITE 200
5948 N College Ave INDIANAPOLIS, IN 46240
Indianapolis, IN 46220 317-846-4622
FEIN: Interstate Risk ID #: Intrastate Risk ID #:
Legal Entity — Limited Liability Company
2. Policy Period: 12/01/2015 to 12/01/2016 at 12:01 AM Standard Time at Your Mailing Address Shown Above
Other Workplaces not shown above: No Additional Locations
3A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed
here: IN
3B. Employers Liability Insurance: Part two of the policy applies to work in each state listed in item 3A. The limits of our
liability under part two are:
Bodily Injury by Accident $100,000 Each Accident
Bodily Injury by Disease $100,000 Each Employee
Bodily Injury by Disease $500,000 Total Policy
3C. Other States Insurance: Part three of the policy applies to states, if any, listed here: All states except those listed in
Item 3.A. and ND OH WA and WY
3D. See attached schedule for list of endorsements forming a part of this policy.
4. The premium for this policy will be determined by our manuals of rules, classifications, rates and rating plans. All
information required below is subject to verification and change by audit.
Classification of Operations
Class
Loc Code Description
See Extension of Information Page
Minimum Premium $354 IN
Assessments and Taxes $10.71
Countersign
Exposure
Expense Constant:
Estimated Annual Premium:
Ber)osit Premium:
(Authorized Representative)
Rate Premium
$1,280.00
$250
$1,530.00
$1,540.71
Date-.,��O
DWC 01 0414 12/08/2015 10:05:26
MARKEL INSURANCE COMPANY
MAMI: DECLARATIONS
SERVICE AND TECHNICAL PROFESSIONS
PROFESSIONAL LIABILITY INSURANCE POLICY
Claims Made and Reported Coverage: The coverage afforded by this policy is limited to liability for only those Claims that
are first made against the Insured during the Policy Period or the Extended Reporting Period, if exercised, and reported to
the Company during the Policy Period or the Extended Reporting Period, if exercised, or within sixty (60) days after the
expiration of the Policy Period or the Extended Reporting Period, if exercised.
Notice: This is a duty to defend policy. Additionally, this policy contains provisions that reduce the Limits of Liability stated in
the policy by the costs of legal defense and permit legal defense costs to be applied against the deductible, unless the policy
is amended by endorsement. Please read the policy carefully.
POLICY NUMBER: MG844515 RENEWAL OF POLICY: NEW
1. NAMED INSURED: TESTING FOR PUBLIC SAFETY, LLC
2. BUSINESS ADDRESS: 5948 N. COLLEGE AVENUE
INDIANAPOLIS, IN 46204
3. POLICY PERIOD: From 12/01 /2015 to 12/01/2016
12:01 A. M. Standard Time at address of Insured stated above
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF
THIS POLICY, THE COMPANY AGREES WITH THE NAMED INSURED TO PROVIDE THE
INSURANCE AS STATED IN THIS POLICY.
4. PROFESSIONAL SERVICES: HUMAN RESOURCES CONSULTING INCLUDING EDUCATIONAL TESTING
AND ASSESSMENTS
5. LIMITS OF LIABILITY:
A. Each Claim:
$ 1,000,000
B. Policy Aggregate:
$ 1,000,000
6 DEDUCTIBLE:
Each Claim:
$ 2,500
7. RETROACTIVE DATE: December 1, 2015
8. RATE: Flat
9. PREMIUM FOR POLICY PERIOD:
Minimum
$ 2,497.00
Deposit
$ 2,497.00
Producer Number, Name and Address
08540
Arlington/Roe & Co.
8900 Keystone Crossing Ste. 800
Indianapolis, IN 46240
MDST 1000 10 10
Page 1 of 2
WEST BEND
A MUTUAL INSURANCE COMPANY -
West Bend Mutual Insurance Company
1900 S. 18thAw. I West Bend, WI 53095
Endorsement
Commercial Liability Umbrella Coverage Declarations
Customer Number: 1000036800 Policy Period: 12/01/2015 to 12/01/2016
Policy Number: A092932 00 at 12:01 AM Standard Time at Your Mailing Address Shown Below
Named Insured and Address:
Testing For Public Safety, LLC
5948 N College Ave
Indianapolis, IN 46220-2554
Aggregate Limit
(Except with Respect to "Covered Autos")
Personal and Advertising Injury Limit
Each Occurrence
Terrorism Risk Insurance Act
Umbrella Premium
Agency Name and Address:
CENTRAL INSURANCE ASSOC INC
70 EAST 91ST STREET, SUITE 200
INDIANAPOLIS, IN 46240-7622
317-846-4622
Limits of Insurance
This is not a bill. A billing invoice will be sent separately.
See attached schedule for forms applicable to all coverage
Countersignature
(Authorized Representative)
13160
$1,000,000
$1,000,000
$1,000,000
Included
$300
DUC 01 02 15 12/14/2015 08:39:50
WEST BEND
A MUT A INSUMNOE COMPANY'
West Bend Mutual Insurance Company
1900 S. 18th Ave. I West Bend, WI 53095 Endorsement
Commercial Liability Umbrella Coverage Declarations
Customer Number: 1000036800 Policy Period: 12/01/2015 to 12/01/2016
Policy Number: A092932 00 at 12:01 AM Standard Time at Your Mailing Address Shown Below
Named Insured and Address: Agency Name and Address: 13160
Testing For Public Safety, LLC CENTRAL INSURANCE ASSOC INC
5948 N College Ave 70 EAST 91ST STREET, SUITE 200
Indianapolis, IN 46220-2554 INDIANAPOLIS, IN 46240-7622
317-846-4622
Retained Limit
Self -Insured Retention Waived
Schedule of Underlying Insurance
Businessowners Liability (SMARTbusiness)
Insurer: West Bend Mutual Insurance Company
Policy Number: A092932 Policy Term: 09-01-2015 to 09-01-2016
Coverage Form: Occurrence
Limits of Insurance:
Each Occurrence
Personal and Advertising Injury
Products/Completed Operations Aggregate
General Aggregate
Automobile Liability
Insurer: West Bend Mutual Insurance Company
Policy Number: A092932
Limits of Insurance:
Each Accident
Employer's Liability
Insurer: West Bend Mutual Insurance Company
Policy Number: A092949
$1,000,000
$1,000,000
$3,000,000
$2,000,000
Policy Term: 09-01-2015 to 09-01-2016
$1,000,000
Policy Term: 09-01-2015 to 09-01-2016
DUC 02 03 15 12/14/2015 08:39:50
WEST BEND
A MUTUAL INSUMNCE COMPANY'
West Bend Mutual Insurance Company
1900 S. 18th Ave. I WCSE Bend, WI 53095
Endorsement
Commercial Liability Umbrella Coverage Declarations
Customer Number: 1000036800
Policy Number: A092932 00
Named Insured and Address:
Testing For Public Safety, LLC
5948 N College Ave
Indianapolis, IN 46220-2554
Policy Period: 12/01/2015 to 12/01/2016
at 12:01 AM Standard Time at Your Mailing Address Shown Below
Agency Name and Address: 13160
CENTRAL INSURANCE ASSOC INC
70 EAST 91ST STREET, SUITE 200
INDIANAPOLIS, IN 46240-7622
317-846-4622
Limits of Insurance:
Bodily Injury by Accident — Each Accident $500,000
Bodily Injury by Disease — Each Employee $500,000
Bodily Injury by Disease — Policy Limit $500,000
DUC 02 03 15 12/14/2015 08:39:50