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North Sanpete School District
Statement of…………….

Board Policy With Guidelines

Policy Number:  IV-72
Effective Date:  07/19/2005
Revised Date:
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Subject:  Risk Management Coverage for Employees             

The Board hereby elects to extend its insurance coverage available from risk management to cover employees in their individual capacities to the extent claims of liability arise from acts performed within the scope of the employee's employment with the School District.

By April 15 of each school year, the School District shall provide a copy to each employee of a disclosure prepared by the state risk manager regarding the coverage against liability provided to School District employees pursuant to Section 63A-4-2-4(4)(b), which information shall include:

  1. The eligibility requirements to receive coverage;
  2. The basic nature of the coverage for School District employees;
  3. Whether the coverage is primary or in excess of any other coverage provided to employees.

The School District shall require all newly hired employees to sign a separate document acknowledging that the employee has received the disclosure described above and that he/she understands the legal liability protection and what is not covered, as explained in the disclosure.  The School District shall retain the signed acknowledgement in the employee personnel file.


North Sanpete School District   

Employee: _____________________________________   Date of Hire: _______________________                        

I am a newly hired employee of the School District and have received from the School District a disclosure of insurance coverage, which is provided to employees through the Utah State Risk Manager.  I state that I have read the disclosure prepared and provided through the Risk Manager through the School District office.  I further state that I understand legal liability protection provided to me and what is not covered, as explained in the disclosure.

My questions or uncertainty about liability protection coverage are as indicated:



Dated this ________ day of _______________________, 20 ____.


Employee Signature