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-2- <br /> <br /> Total.number of county employees-(not including m~ntal health, <br /> but including all Other merit system employees such as social <br /> services and health; also not inclhding school employees) ~ <br /> <br />5. Would your county be interested in purchasing such liability <br /> insurance coverage if available at a reasonable cost (for example: <br /> at a cost of $7.50 per person annually)? <br /> <br />6. (Answer this question only if information is readily available.) <br /> / <br /> List of claims or potential claims for the last three (3) years <br /> which would have been covered by a Public Officials and Employees <br /> Liability Insurance plan (whether or not actually covered by <br /> insurance). Include the following information for each claim: <br /> <br /> (a) approximate date of occurrence giving rise to the claim <br /> <br /> (b) department involved <br /> <br /> (c) employee involved (by position, not name) <br /> <br /> (d) alleged act or omission involved (i.e., bodily injury, <br /> false arrest, libel, violation of civil rights, etc.) <br /> <br /> (e) amount of actual payment to claimant (if any) <br /> <br /> (f) defense cost (if known) <br /> <br /> Claim 1 Claim 2 <br /> <br /> (a) (a) <br /> <br /> (b) (b) <br /> <br /> (c) (c) <br /> (d) (d) <br /> (e) (e) <br /> (f) (f) <br /> <br /> <br />