DEBORAH Hospital Foundation - Liability Insurance Forms

212 Trenton Road Browns Mills, NJ 08015 (609) 283-9029

DIRECTIVE ON LIABILITY INSURANCE

Although Deborah does carry “Blanket Liability” insurance for its normal business activities, Chapter events are not automatically covered. Each Chapter is responsible for submitting all of the forms outlined in this section. Please copy the forms as needed.

With your help and cooperation, we can continue to have the broadest scope of Chapter fundraising with adequate insurance protection.

A. Primary Responsibility: It is the responsibility of the appropriate Chairperson to coordinate and make
sure that the National Office is informed four to six weeks in advance of all Chapter affairs.

B. National Office responsibility:

1. Approve each event for insurance purpose

2. Authorize the signing of any agreements, contracts, leases, etc.

3. Review and approve insurance coverage carried by suppliers

4. Issue any evidence of insurance required

C. Contents/Procedures:

1. Notification of Events

a.       Complete a form for each event, four to six weeks in advance of the event, and mail to the National
         Office, along with a copy of any contracts or leases associated with the event. DO NOT SIGN
         ANY CONTRACTS OR LEASES UNTIL YOU RECEIVE APPROVAL OF THE EVENT FROM
          THE NATIONAL OFFICE.

b.       The Chapter will be advised that the event is approved and whether or not any agreement can
           be signed.

                 The Chapter will be advised if any additional action is necessary for approval of the event.

Please Note:

* If an event will be occurring on a regular basis, such as monthly meetings, bingo games, etc., one form
may be used to report up to a year’s activity.

*    An event form is required for ALL activities held in the name of Deborah. This includes, but is not
       limited to: general and Board meetings, luncheons, auctions, trips, bingo games, raffle sales at community
       locations and canister collections.

2. Certificate of Insurance Request for Outsiders

           a.    When services for products are being provided by outsiders, i.e., bus companies, travel agents,
                  caterers, restaurants, water craft (not Deborah volunteers), the Chairperson must request Certificate
                  of Insurance from each entity. Requests for certificates of insurance are not needed for the
                   following events if estimated participants are below 100: (If there are going to be over 100
                   participants in a calendar year then a certificate of liability has to be requested).

Card Parties
Auctions
Fashion Shows
Gift Wrapping
Luncheons
Raffle Ticket Sales
General Membership and Board Meetings
Restaurants/Hotels
Theaters

b.    When using outside facilities, i.e., rental facilities, Agreement For Use of Premises must be
       completed.

c.    Sample letters with instructions are attached. If you are not notified of receipt within two (2)
         weeks follow-up until received. Send a copy of your letter to the National Office.

        Services or Products

        Transportation Services

d.    Forward copies of all certificates received to the National Office and advise of any entity that will
       not or cannot supply the requested certificate.

e.    The Chapter will be advised of the acceptability of the information received from your suppliers.

3. Evidence of Insurance Coverage for an Event

              a.    The Chapter will receive, when the event is approved, an acknowledgment that insurance
                     coverage is being provided.

             b.     A certificate of Deborah’s insurance coverage will be issued, when required by the owner of a
                    premises, township or municipality.

4.    Releases, Agreements Necessary from Others

            a.    When the National Office approves an event, if any special requirements are necessary, the
                   Chapter  will be informed.

            b.    If you are sponsoring any form of athletic event including walk-a-thons, bike-a-thons, etc., each
                  participant (if a minor, his/her legal guardian) must sign a release, (Athletic Waiver Form) or they
                  may not participate in the event. If a motorized unit is used, submit a completed Motorized Unit
                 Waiver Form. This is imperative!!!

            c.   When vendors are displaying and/or selling their wares, it is necessary that they sign a release
                  prior to being allowed to exhibit – Exhibit Waiver Form.

            d.   If an event involves a travel agent, always request the following: They must produce a copy of
                  their travel bond in the amount of $10,000.00 or more. They must prove they have been in business
                 no less than 3 years and they’ve been successful.

            e.   If an event involves bingo always request a copy of their insurance coverage regardless of the
                  number of participants. However, if hall is free (no rental fee or percentage of take is paid), then no
                 certificate will be required.

            f.   For any event involving liquor, a certificate must be requested including liquor liability
                 coverage. (Liquor price cannot be included in the ticket price).

            g.  Once all releases are complete, they must be forwarded to the National Office to be held on file.

The following types of events should always be reviewed before making a decision to proceed: any type involving swimming, amusement rides, fairs, carnivals, aircraft and watercraft (cruise ships).

Deborah has no insurance for exposure to losses arising out of or on watercraft (cruise ship) or aircraft. Therefore, great care is needed. Further, water sports, amusement rides and animals present exposures that underwriters
may not want, so coverage available from others is very important.

5.    Notification of Incident

          a.   A person in the Chapter who will be attending the event should be responsible for completing
               an Incident Report Form if necessary. This report should be made whether or not the individual
               involved indicated their intention to make a claim. This would include such incidents as a slip, trip,
               fall, cuts, bruises, verbal or physical altercations involving guests, volunteers, etc.

          b.   Should you receive formal notice of a claim after an event, complete the Incident Report Form as best
               as can be remembered, and forward it immediately along with any correspondence on this matter to:

DeborahHospital Foundation

National Chapter Services & Support

20 Pine Mill Road

Browns Mills, NJ08015

Printable Notification of Event Form

Printable Agreement for Use of Premises Form

Printable Services or Products Form

Printable Letter for Transportation Form

Printable Athletic Event Waiver Form

Printable Motorized Unit Waiver Form

Printable Exhibitor Waiver Form

Printable Incident Report Form