LiabiLity

insurance

Program

LiabiLity

insurance

Program

LiabiLity

insurance

Program

LiabiLity

insurance

Program

March 31, 2013 to March 31, 2014

Benevolent and Protective Order of Elks

LiabiLity

insurance

Program

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Benevolent and Protectiveorder of elks

LIABILITY INSURANCE PROGRAMMarch 31, 2013 to March 31, 2014

Program Guide: Procedures, Coverages, Claims Reporting and Loss Prevention

(For Further Loss Control Advice, Refer to Accident Claims Prevention Manual)

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Insureds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Coverage Scope Policy Information Coverage Limits

Coverage Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6

Coverages Not Included . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Insurance Certificates (Issued for B.P.O.E. Activities) . . . . . . . . . . . . . . . . 8 Sample Certificate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 12

When Local Lodge Should Require An Insurance Certificate . . . . . . . . . . 10

Indemnification (Hold-Harmless Agreement) . . . . . . . . . . . . . . . . . . . . . . 11

Claim Reporting (Accident Report Forms) . . . . . . . . . . . . . . . . . . . . . . . . 13 Sample Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15

Loss Prevention Program [Disclaimer] . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 I . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 II . Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Self-Inspection Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 III . Accident Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 IV . Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 V . Fire Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 VI . Crime Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 VII . First Aid and CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-28 VIII . Alcohol Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

— TABLE OF CONTENTS —

— 1 —

BENEVOLENT and PROTECTIVE ORDER of ELKS

Liability Insurance Program

— ADMINISTRATION —

The B .P .O .E . Liability Insurance Program was renewed on March 31, 2013 . Coverage applies to all Local Lodges, State Associations exclusive of state major projects and the Grand Lodge . (Note: Coverage for proposed new Lodges is effective on granting of dispensation by the Grand Exalted Ruler.)

Included with this Guide are the following:

A General Description of the Program

An Insurance Certificate (see Certificate section for further instructions)

Claim Forms

Address and telephone number of the claim reporting office

A Loss Prevention Program (Avoiding loss will save the Local Lodge money.)

Aon Affinity Services, Inc . is appointed as insurance broker and advisor for this program .

aon affinity services, inc.— Elks Insurance Team —

200 E . Randolph Street5th Floor

Chicago, Illinois 60601-6416Phone 1-800-421-3557 (E-L-K-S)

Fax (312) 381-2751

— 2 —

— COVERAGE —Questions pertaining to Coverage should be directed to the Director or one of the following members of the Program Team at the 800 number or the direct dial numbers indicated .

Sheldon Staubitz, Director (773) 755-4714 Grand Lodge Insurance Department

— OR —

Aon Affinity Services — [The Elks Team] (800) 421-3557 Debbie Downey (312) 381-2727

Questions pertaining to the Per Capita Assessment funding the Program should be directed to the Office of the Grand Secretary .

— CLAIMS —Questions pertaining to reporting and handling Master Liability Claims and handling Property Plus Claims should be directed to Gallagher Bassett Services, Inc.

Initial reporting of Property Plus Claims is to be made to Aon .

[Mailing Address] [Location] P . O . Box 7110 1901 S . Meyers Road, 2nd Floor Oakbrook Terrace, IL 60181-7110 Oakbrook Terrace, IL 60181-5243 (see Claim Reporting section on page 13 of Liability Insurance Program book for complete instructions) .

Toll-Free Telephone 1-(800) 962-7088 Toll-Free Fax Number 1-(800) 223-7006

— 3 —

— INSUREDS —The Named Insureds under this Program are:Benevolent and Protective Order of Elks of the United States, The Grand Lodge of the Order, The National Service Commission of the Order, The National Memorial and Publication Commission of the Order, The National Convention Commission of the Order, The Grand Forum of the Order, The Elks National Foundation, The Elks Magazine of the Order, The Veterans Memorial Restoration Trust and The Elks National Home .

State Associations Officially Recognized by the Order .

Local Lodges of the Order operating under charters and dispensations issued by the Order and in force and effect .

All separate Corporations organized by Local Lodges and existing under Section 16 .030 of the Statutes of the Order or predecessor statutes .

Ladies’ Auxiliaries of the Local Lodges, whether formally recognized or not, while acting on behalf of the Local Lodge (coverage is not included for any activities of state or national Auxiliary organizations) .

Subsidiary Companies (including Subsidiaries thereof) of a Named Insured and any other Company coming under the Named Insured’s control of which it assumes active management .

The Persons Insured under the Program are:Any Executive Officer, Director, Stockholder, Trustee, Committeeman, Volunteer Worker, or Agent of a Named Insured while acting within the scope of his duties as such for the Named Insured .

Any member of a Named Insured Lodge but only for liability arising out of the operations of the Named Insured .

Any Employee of the Named Insured while acting within the scope of his duties as such, but the insurance afforded to such Employee does not apply to bodily injury to another Employee of the Named Insured arising out of or in the course of his employment .

NOTE: Specifically excepted and excluded herefrom are the Major Projects of State Associations (as defined in the current “Grand Lodge and State Associations Directory” published by the Grand Lodge of the Order) and any Executive Officer, Director, Stockholder, Trustee, Committeeman, Volunteer Worker, Employee or Agent of the Major Project.

This Resumé of Coverage is intended to facilitate your understanding of the Insurance Program. However, it IS NOT intended to Replace or Supersede any of the Contracts of Insurance obtained under this Program.

— 4 —

— GENERAL INFORMATION —Pursuant to authority given at the 1984 Grand Lodge Session, a Liability Insurance Program was established to provide coverage for all Local Lodges, State Associations and the Grand Lodge . The program became effective on October 1, 1984 . [Section 4.231, GLS]

The following information applies for the policy period beginning March 31, 2013 and ending March 31, 2014 .

COVERAGE SCOPE 1. Commercial General Liability Insurance including Liquor (“Dramshop”)

Liability, Product Liability, Contractual Liability and Personal Injury Liability . 2. Non-owned and Hired Automobile Liability Insurance . (Note that coverage

does not apply to the vehicle itself, the owner of the vehicle, or any vehicle owned by the Lodge.) (Also note exclusion H.)

3. Employers Liability Insurance (Stop-Gap) is provided for entities located in those States with laws requiring purchase of Workers’ Compensation insurance from a State Fund .

POLICY INFORMATIONInsurance Company Names, Policy Numbers and Policy Limits are listed in the specimen Insurance Certificate included (see Insurance Certificate section on page 9) .

COVERAGE LIMITSUnder this plan, the first $1,000,000 of aggregate losses occurring in each section of coverage is assumed by the Master Liability Program, which is funded out of the per capita assessment . Should a loss or losses occur, this $1,000,000 would be borne by the program . The Local Lodges have coverage on a first dollars basis .There is a 50 million dollar per occurrence limit . 1. For general liability exposures (premises operations, Lodge operations on or

off premises), personal injury, non-ownership hired car coverage, fire damage liability, and other stated coverages .

2. For liquor liability exposures . 3. For products and completed operations .

— COVERAGE DESCRIPTION —COMMERCIAL GENERAL LIABILITY INSURANCEProtection is afforded against legal liability resulting from bodily injury/property damage which arise from insured Elks’ activities . In addition to payment of damages, the Program also provides payment for investigation and legal defense .

Premises — OperationsCovers liability for bodily injury and/or property damage arising from the use of owned or leased premises or Lodge activities off premises .

— 5 —

Personal Injury — Advertising InjuryCovers injury arising out of libel, slander, violation of an individual’s right of privacy or occupancy, discrimination, false arrest, detention, malicious prosecution, or wrongful eviction . (Coverage for claims of libel or slander by membership candidates arising out of the membership selection process at the Local Lodge level are excluded.) (Discrimination coverage is limited to controversies regarding membership requirements established by the Statutes of the Order.)

Contractual LiabilityCovers bodily injury and property damage liability of an insured arising from a contract relating to the conduct of the Named Insured’s business .

Independent ContractorsCovers an Insured’s liability for actions of contractors hired to perform work on an Insured’s premises or whose activities are related to an Insured’s operations .

Liquor LiabilityCovers claims brought against an Insured based on the selling or serving of alcohol, either on an Insured’s premises or at an Insured’s sponsored activity away from the premises .

Product LiabilityCovers an Insured’s liability for injury or damage caused by the Insured’s products, occurring away from the Insured’s premises and after physical possession has been relinquished to others .

Fire Legal LiabilityCovers damages for which an Insured is legally responsible which result from a fire at premises leased from others . (Coverage is not provided in circumstances where there has been a failure to obtain coverage required under a contract.)

Non-Owned Watercraft LiabilityCovers liability for operation of watercraft (under 52 feet in length) not owned by a Named Insured .

Employee Benefits LiabilityCovers legal obligations for damages sustained by an employee, prospective employee, former employee or beneficiaries, caused by any negligent act, error, or omission of the Insured or his employees in the administration of Employee Benefit Plans . (A group program provided by an employer .) Coverage is afforded only for claims “first made” during the policy period, regardless of when the negligent act occurred . (Employee Benefit Plans are: group life, accident and health, profit sharing, IRS qualified pension, unemployment, or disability plans.)

Pesticide and Herbicide Applicators Liability (Golf Courses Only)Covers bodily injury or property damage arising out of the use and application of Herbicides and Pesticides on owned or leased premises if use meets all standards of any statute, ordinance, regulation or license requirement of any federal, state or local government having application to such operation or if such discharge, dispersal, release or escape is sudden and accidental .

Media Liability CoverageThis coverage provides protection for losses that may result from publications and internet exposures normally associated with Lodge operations . Coverage is afforded for, defamation and disparagement, invasion, infringement or interference with rights of privacy or publicity, infringement of title, slogan, trademark, trade name, trade dress, service mark, service name, copyright or plagiarism, and unfair competition in conjunction with certain types of claims . (There is a single blanket limit covering all Elks entities .)

— 6 —

Non-Owned and Hired Auto LiabilityThis coverage protects against damages for which an Insured is legally liable which result from the use of a non-owned or hired automobile . No coverage is obtained for uninsured or underinsured motorists, and the policy specifically rejects and excludes any coverage of this type .

Coverage DOES NOT apply: to damage to the vehicle being used, to vehicles owned by an Insured, or member of his household, to protect the owner of the vehicle rented or borrowed .

Officers, Committeemen, Employees, Members & Volunteers as Additional InsuredsProvides protection for such persons when acting within the scope and course of their duties for the employment by the Named Insured, against the types of claims outlined above .

Pertinent Exclusions & Limitations A. No coverage is afforded for state or national Ladies Auxiliary organizations . B. No coverage is afforded for claims alleging errors in judgment or mistakes in

operations of either a Lodge or Club or employment practices . C. No coverage is provided for claims involving pollution or which are related in any way

to asbestos, lead or mold . (Except the limited coverage afforded for golf courses.) D. No coverage is provided for bodily injury or personal injury to an employee, former

employee, or applicant for employment arising out of their employment for an Insured or caused by another employee of the Insured .

E. To any obligation for which the Insured or any carrier as his Insurer may be held liable under any workers compensation, unemployment compensation or disability benefit law, or under any similar laws . (It is strongly recommended that all Lodges independently obtain a minimum premium workers’ compensation coverage, even if they have no permanent employees.)

F. No coverage is provided for claims of libel or slander by membership candidates arising out of the membership selection process at the Local Lodge level .

G. Bodily injury or property damage arising out of the use of mobile equipment (including, but not limited to, all terrain vehicles, dirt bike motorcycles, lawn mowers, utility vehicles) in competition or racing events or in practice or for general recreational use or stunting or in preparation for such activities .

H. Coverage under the Master Liability Program may not be provided to any insured entity or person that does not cooperate in the investigation and defense of any claim made under the Program or in the case of failure to provide all notices or legal complaints in a timely fashion to the claims administrator .

IMPORTANT NOTECoverages provided are excess over any other valid and collectible insurance.This Resumé of Coverage is intended to facilitate your understanding of the insurance program. However, IT IS NOT intended to replace or supersede any of the contracts of insurance obtained under this program.

— 7 —

— COVERAGES NOT INCLUDED —Since the Program deals solely with Liability Insurance, there are a number of exposures which your Lodge or Association must evaluate and insure separately . Among them:

Fire, Extended Coverage and other perils on real and personal property .*Damage to Boiler, Pressure Vessels, Air-Conditioning Systems and other Mechanical / Electrical Equipment .*Directors and Officers Liability . (This type of coverage refers primarily to misjudgment in Lodge management or possibly to discriminatory practices .)**Insurance on Owned Vehicles. No coverage is provided for any person for uninsured or underinsured motorists . This coverage has been excluded and rejected for vehicles of any type .Owned Watercraft over 18 feet in length or any watercraft propelled by sail, engine power or electrical power regardless of length .Non-Owned Watercraft over 52 feet in length .Owned Aircraft.Pollution Liability . This may be important to Lodges that have a potential for discharging any waste products in the environment, which utilize large amounts of chemical such as insecticides in their operations, or have underground fuel storage tanks . No coverage is provided for exposure to asbestos, lead or mold . (Limited coverage is provided for golf courses under some circumstances.)

Accident, health, life or disability, or any employee benefit coverage .Employee Dishonesty (including required bonds on Lodge Officers) .*Robbery and Safe Burglary.*Surety Bonds of any kind, including those required by federal, state or local governmental bodies .Workers’ Compensation.***Liability for tenants or independent contractors.Insurance on personal autos, residences or other property of officers and members even if they are used occasionally for Lodge or Association business .Employment Practice Coverage . (This coverage includes wrongful discharge, discrimination of all types and sexual harassment .)**Claims arising from the Business risk of operations which do not involve bodily injury or property damage .Breach of contract claims which do not involve bodily injury or property damage .

* L ocal Lodges must be covered in Grand Lodge Property Plus Program . (If coverage of this type is purchased by a Local Lodge .) [Section 4 .232]

** C an be obtained through the voluntary program available to Local Lodges through Aon Affinity ServiceS [The Elks Team] at 1-800-421-3557 .

*** Can be obtained from Lockton at 1-877-735-6349 .

— 8 —

— INSURANCE CERTIFICATES —The function of an Insurance Certificate is to provide the parties requiring the certificate, i.e., Certificate Holder with evidence that various obligations can be satisfied – e.g., pay liability losses assumed under contract, pay for loss or damage to property for which it is responsible .

WHEN YOU ARE REQUIRED TO PROVIDE EVIDENCE OF INSURANCE:If an Insurance Certificate is required by a third party in connection with a lease of premises, special event or other activity, contact:

aon affinity services, inc. [The Elks Team]200 E . Randolph Street5th FloorChicago, Illinois 60601-64161-800-421-3557 (E-L-K-S)

You will need to provide the following:

o Name and address of Certificate Holder .

o Nature of the activity (i.e., lease, special event, etc .) .

o Date of event .

o Whether or not the Certificate Holder is to be named an Additional Insured under the Program. (There are strict limitations to the issuance of additional Insured Certificates for activities not related to normal Lodge operations or the serving of alcohol to the public or for hazardous events.)

o Any special requirements as to the insurance limits or Certificate wording . (Provisions related to hazardous events or requiring hold harmless or indemnity agreements must be reviewed and approved.)

We recommend that Certificate requests be made in writing . If time does not permit a written request, however, you may telephone the service agent at (800) 421-3557 .

The Certificate included with this Guide on the next page is for information only .

Review ALL documents signed on behalf of the Lodge.

DO NOT provide indemnification to others without a full review by the Lodge’s attorney.

The Elks Master Liability Program is NOT TO BE USED to provide coverage for activities

of other organizations or for business operations not related to normal Lodge functions.

— 9 —

CERTIFICATE OF LIABILITY INSURANCEDate (MM/DD/YYYY)

3/20/2013

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCERAon’s Affinity Insurance Services, Inc.The Elks Insurance Program200 E Randolph, 5th FloorChicago, IL 60601

CONTACTNAME: D, A, DowneyPHONE(A/C, No, Ext): (800) 421-3557

FAX(A/C, No): (312) 381-2751

INSURER(S’ AFFORDING COVERAGE NAIC #INSURER A: Old Republic Insurance Company 24147

INSURED INSURER B: Westchester Fire Ins CoBenevolent and Protective Order of Elks of U.S.A INSURER C: Lexington Insurance Company

INSURER D: Liberty Insurance CompanyINSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL OF THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

COLTR

TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIV

E DATE

POLICY EXPIRATION

DATE

LIMITS

A GENERAL LIABILITYCOMMERCIAL GENERAL

LIABILITY

CLAIMS MADE OCCURLIQUOR LIABILITY MWZY 59979 3/31/13 3/31/14

GENERAL AGGREGATEPER OCCURRENCEPRODUCTS-COMPLETED OPSAGGREGATEPERSONAL & ADV /INJURYLIQUOR LIABILITY EACH COMMON CAUSE LIQUOR LIABILITYAGGREGATE

$1,000,000$1,000,000

$1,000,000$1,000,000

$1,000,000

$1,000,000

A AUTOMOBILE LIABILITYANY AUTOALL OWNED AUTOSSCHEDULED AUTOSHIRED AUTOSNON-OWNED AUTOS

MWZY 59979 3/31/13 3/31/14 EACH ACCIDENTEACH ACCIDENT

$1,000,000$1,000,000

BEXCESS LIABILITY

UMBRELLA FORMOTHER THAN UMBRELLA FORM

G22012526008 3/31/13 3/31/14 EACH OCCURRENCEGENERAL AGGREGATE PER LOCATION

$9,000,000

$9,000,000

CEXCESS LIABILITY

UMBRELLA FORMOTHER THAN UMBRELLA FORM

006502510 3/31/13 3/31/14 EACH OCCURRENCEGENERAL AGGREGATE PER LOCATION

$25,000,000

$25,000,000

DEXCESS LIABILITY

UMBRELLA FORMOTHER THAN UMBRELLA FORM

EXC SF 077036-13 3/31/13 3/31/14 EACH OCCURRENCEGENERAL AGGREGATE PER LOCATION

$15,000,000

$15,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)Insured Lodge: Elks Lodge # Event: Location: Date: THE CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED AS RESPECTS TO THE INSURED’S OPERATIONS DURING THE DESCRIBED EVENT OR ACTIVITY NOTED ABOVE HIRED AND NON-OWNED AUTO COVERAGE IS SUBJECT TO THE GENERAL AGGREGATE

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

1988-2009 ACORD CORPORATION. All rights reserved.ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

— 10 —

— WHEN LOCAL LODGE SHOULD REQUIRE AN INSURANCE CERTIFICATE —

Generally, it is a good business practice to require any entity or person utilizing or working on your premises or at a sponsored event to provide you with an Insurance Certificate as evidence of insurance coverage . This applies to renters of the facilities on a long term basis, a single event, and independent contractor performing services for your Lodge, be it a building contractor, restaurant or bar concession, or a corporate reception . (It is always recommended that a contract with a hold-harmless provision be obtained and that the Lodge be named additional insured.)

How to obtain:Your Lease Agreement or Rental Agreement should contain an indemnification and hold-harmless provision establishing the responsibility of the tenant or renter with respect to liability claims arising out of their use of the premises .

This Agreement should also contain a section of insurance requirements . The other party should provide you with evidence of insurance naming the Lodge Additional Insured before they are given use of your premises .

In your requirements, you should ask that your Lodge be added as an “Additional Insured” with respect to the event or use of facilities . Being named an Additional Insured will provide you with liability protection under the user’s policy, and therefore, if a loss occurs, the B .P .O .E Master Liability Policy may not be called upon to pay damages . (This will help keep the costs of your program down.)

What information do you need:It is important to establish your priorities in who should be allowed use of the Lodge and in requesting and reviewing evidence of insurance .

The evidence of insurance should include:

o Name of Insurance Company

o Named Insured and Address

o Description of Coverage — Comprehensive General Liability, including Products, Contractual Liability insuring the indemnification, and Workers’ Compensation

o Policy Numbers

o Policy Periods

o Limits of Liability

o Description and Location

o Your Name and Address as Certificate Holder and indication Lodge is named Additional Insured

o Notice of Cancellation Provision

o Authorized Signature

— 11 —

— INDEMNIFICATION —The following language is suggested with respect to indemnification of a Local Lodge by lessees and contractors:

For valuable consideration, the receipt whereof is hereby acknowledged, _____________________ does hereby agree to indemnify and hold ________________________ Lodge No . __________ harmless from any and all claims, cost of defense, or expense arising out of (description of activities), except for the sole negligence of the Lodge . _____________________ further agrees to provide the Lodge with evidence of the following insurance coverages naming the Lodge as an additional insured under the General Liability Policy with a separate endorsement reflecting this action, with companies satisfactory to the Lodge and with provision in the policies for thirty days’ notice of cancellation or material change . Such coverage and certificate must be issued without disclaimer or any limitations .

COVERAGE AMOUNT GENERAL LIABILITY $1,000,000 per occurrence (including products and contractual liability)

AUTOMOBILE LIABILITY $1,000,000 per occurrence (where applicable)

WORKERS’ COMPENSATION STATUTORY (where applicable)

(Amounts of required coverage might be increased or reduced depending on circumstances .)

(Refer to next page for recommended form of certificate you can request to provide evidence of insurance to your Lodge .)

— 12 —

GENERAL LIABILITY

COMMERCIAL GENERAL LIABILITY

CLAIMS MADE OCCUR

___________________________________

___________________________________GEN’L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC POLICY JECT LOC

WC STATU-TORY LIMITS

ACORDTMDATE (MM/DD/YY)CERTIFICATE OF LIABILITY INSURANCE

PRODUCER

INSURED

INSURERS AFFORDING COVERAGE

INSURER A: INSURER B: INSURER C: INSURER D: INSURER E:

E.L. EACH ACCIDENT $500,000E.L. DISEASE – EA EMPLOYEE $500,000E.L. DISEASE – POLICY LIMIT $500,000

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS

The certificate holder stated below will be considered an additional insured under the policies, and an endorsement noting this action has been issued. No disclaimer or limitations of any kind apply to this certificate.

CERTIFICATE HOLDER

COVERAGES

OTH-ER

ADDITIONAL INSURED; INSURED LETTER: _________ CANCELLATION

Should any of the above coverage be cancelled or materially changed, the issuing company will provide 30 days notice.

AUTHORIZED REPRESENTATIVE

THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSRLTR TYPE OF INSURANCE POLICY NUMBER LIMITS

EACH OCCURRENCE $1,000,000 FIRE  DAMAGE  (Any one fire)  $1,000,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 PRODUCTS – COMP / OP AGG $1,000,000

POLICY EXPIRATIONDATE (MM/DD/YY)

POLICY EFFECTIVE DATE (MM/DD/YY)

XX

X Contractual

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS

__________________________________

X

GARAGE LIABILITY

ANY AUTO

EXCESS LIABILITY

OCCUR CLAIMS MADE

DEDUCTIBLE

RETENTION $WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY

OTHER

COMBINED SINGLE LIMIT (Ea accident)

$1,000,000

BODILY INJURY $(Per person)

BODILY INJURY $(Per accident)

PROPERTY DAMAGE $(Per accident)

AUTO ONLY – EA ACCIDENT $

OTHER THAN EA ACC $_______________AUTO ONLY:

AGG $

EACH OCCURRENCE $

AGGREGATE $

$

$

$

X

ACORD 25-S (4/04)

B.P.O. Elks Lodge Number _________________(address)

© ACORD CORPORATION 1988

— 13 —

— CLAIM REPORTING —Liability losses (i.e., injury to a third party or damage to his property) should be reported to Gallagher Bassett Services, Inc . Report all known claims or incidents which you believe will result in a claim . If in doubt, always err on the side of reporting .

Losses involving serious bodily injury as well as any and all lawsuits should be reported immediately by telephone.

Workers Compensation claims of Lodge employees injured on the job must be reported to your local workers compensation insurance

company, not to Gallagher Bassett.

Accident Report FormsEach Lodge and State Association should have claim forms on file at all times . Should you have any questions or require additional supplies, you may contact Gallagher Bassett Services, Inc . directly . (A copy of the Accident Report Form is provided on the following pages.)

IMPORTANT! All accident reports and other correspondence must bear your Lodge Name and Lodge Number or name of State Association. Also, include the name, address and telephone number of the person making the report.

Send original of the report to Gallagher Bassett Services, Inc . and retain one copy of the report for your file .

Correspondence with Gallagher Bassett Services, Inc . pertaining to claim matters should be directed to:

Gallagher Bassett Services, Inc., National Claims Unit [Mailing Address] [Location] P . O . Box 7110 1901 S . Meyers Road, 2nd Floor Oakbrook Terrace, IL 60181-7110 Oakbrook Terrace, IL 60181-5243

Toll-Free Telephone 1-(800) 962-7088Toll-Free Fax Number 1-(800) 223-7006

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NAME ADDRESS

CITY STATE ZIP CODE PHONE

NAME ADDRESS

CITY STATE ZIP CODE PHONE

DATE OF LOSS TIME OF LOSS LOCATION OF LOSS

CITY STATE ZIP CODE

OFFICIALS CALLED TO SCENE IDENTIFY LOSS

POLICE FIRE DEPT. AMBULANCE

Have you reported this claim by telephone?______________ If so, date reported?_______________________________Is the Claimant a Member of the Elks?_____________ Is the Claimant an Employee of the Elks? _______________

Remarks

LODGE # LODGE NAME ADDRESS

CITY STATE ZIP CODE PHONE

NAME AGE ADDRESS

CITY STATE ZIP CODE PHONE

DESCRIBE INJURY IS CLAIMANT EMPLOYED BY LODGE?

YES NOCLAIMANT’S EMPLOYER AND ADDRESS STATE ZIP CODE EMPLOYER’S PHONE

DATE OF REPORT SIGNATURE AND TITLE

CLAIMANT IS NOT TO SIGN OR MAKE REPORT.

CLAIMANT

DESCRIPTION OF LOSS (WHAT HAPPENED?)

WITNESSES

Immediately after an accident, fill out this form and send to:

GALLAGHER BASSETT INSURANCE SERVICE(See Reverse For Complete Instructions)

ACCIDENT REPORT(Please fill in all spaces—This form is to be completed

by Lodge management, NOT by the Claimant)

®

B.P.O. ELKS

LODGE #________________

THIS ACCIDENT RESULTED IN:

BODILY INJURY

PROPERTY DAMAGE ONLY

CLIENT: B. P. O. ELKS

ACCIDENT

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Important

CLAIM PROCEDURESSerious Accidents and All Lawsuits should be reported by telephone immediately to:

Gallagher Bassett Services, Inc.Toll Free Call 1-800-962-7088Toll Free FAX 1-800-223-7006

This form contains the information necessary to investigate potential liability claims. Please complete it in as much detail as possible and forward it to Gallagher Bassett Services, as instructed above. On receipt, Gallagher Bassett Services will coordinate handling and claim adjustment.

Any claim from an employee injured on the job should be reported to the Lodge’s Workers Compensation Insurance company, not Gallagher Bassett Services. Any other claim by an employee for alleged wrongdoing should be reported to the Lodge’s Directors and Officers Insurance carrier.

Written Accident Reports and all claim documents should be mailed to:

Gallagher Bassett Services, Inc. [Mailing Address] [Location] P. O. Box 7110 1901 S. Meyers Road, 2nd Floor Oakbrook Terrace, IL 60181-7110 Oakbrook Terrace, IL 60181-5243

Applicable in CaliforniaFor your protection, California Law requires the following to appear on this form:It is unlawful to:

(a) Present or cause to be presented any false or fraudulent claim for the payment of a loss under a contract of insurance.

(b) Prepare, make or subscribe any writing, with intent to present or use the same, or allow it to be presented or used in support of any such claim.

Every person who violated any provision of this section is punishable by imprisonment in the state prison, or by fine not exceeding one thousand dollars ($1,000) or by both.

Applicable in Florida, Idaho, and New YorkAny person who Knowingly and with intent to Injure, Defraud, or Deceive any Insurance Company Files a Statement of Claim Containing any False, Incomplete or Misleading information is Guilty of a Felony*+

* In Florida - Third Degree Felony In Third Degree - Class A Misdemeanor + In New York - Insurance Fraud: In Second Degree - Class E Felony In First Degree - Class D Felony

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BENEVOLENT and PROTECTIVE ORDER of ELKSLoss Prevention Program

Under the Master Liability Insurance Program of the Order, the funds generated by the per capita assessment pay necessary premiums, the cost of claims handling, and losses which are less than the retention (deductible) .The number and amount of losses have a direct impact on the per capita assessment required to fund the program . Therefore, it is in the best interest of the Local Lodges that they engage in successful loss prevention practices .With this interest in mind, the Statutes of the Order were changed in 1992 (Section 12 .070) to require that each Local Lodge appoint an Accident Prevention Manager from the members of the Board of Trustees (this designated Trustee may have a deputy or deputies). [See page 48 of the Accident/Claim Prevention Manual, 5th Edition, for suggested job description.]

— DISCLAIMER —The B .P .O . Elks of the USA (Grand Lodge) has prepared this information to assist the Local Lodges of this Fraternal Order .Each of these Local Lodges is an independent corporation or other type of entity formed within the state in which it resides . The Grand Lodge of the Order has no control over the day-to-day operations or the personnel practices of these entities and does not undertake any responsibility for the enactment of the recommendations in this program booklet or for any inspection, monitoring, or enforcement of the described recommendations .The establishment and implementation of accident prevention activities and other procedural policies of each Local Lodge are the responsibility of the management of the Local Lodge . The Grand Lodge is neither responsible nor empowered to be responsible for the establishment of such procedures . Also, the Grand Lodge is neither responsible nor empowered to be responsible for the monitoring of the effectiveness of such policies .

I. INTRODUCTIONWHAT IS LOSS PREVENTION? 1. Loss prevention is a methodical procedure which, if followed consistently, will enable

Lodges to identify loss causing situations and prevent accidents . 2. Loss prevention is a means of recognizing and preventing accident potential to

members, guests, employees and physical assets . 3. Local Lodges are solely responsible for proper maintenance of their facilities

and regulation of their activities as they relate to loss prevention .This program has been developed and distributed by the Grand Lodge to assist the Lodges in their proper discharge of that responsibility .

WHY LOSS PREVENTION?Successful loss prevention programs will save Lodges money by reducing the direct and indirect cost of losses encountered in daily operations . In addition to insured or “covered” losses, each accident spawns a series of uninsured or hidden costs . These result in dollars paid out by the Lodge, not the insurance company . The control of losses is a critical function in eliminating:

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Time spent on accident investigation Cleanup after accident or loss Damage to personal property and/or your premises Loss of income Adverse public relationsThese hidden costs may be more important to the Lodge than the “covered” loss itself .Loss Prevention will result in cost control, both direct and indirect . It’s your Lodge – it’s your money . It makes great sense to protect your investment and your membership .

WHO PERFORMS LOSS PREVENTION ACTIVITIES?Under the provision of Section 12 .070 of the Statutes of the Order, the Accident Prevention Manager appointed from the membership of the Board of Trustees or his deputy or deputies are responsible for Lodge accident prevention activities . Ultimately, however, all Lodge officers and members have accountability for a successful loss prevention program . To assist the Local Lodge and to provide a supportive resource, each State Association has in place an Accident Prevention Chairman . The Director of the Insurance Department is also available to provide assistance and advice . [See page 48 of the Accident/Claim Prevention Manual, 5th Edition, for suggested job description.]

WHEN SHOULD LOSS PREVENTION ACTIVITIES TAKE PLACE?Loss Prevention is an around-the-clock activity . It includes safety while the Lodge is open and proper security while the premises are closed . Loss-causing situations and hazards should be remedied immediately . Effective loss prevention is a vital component in a well operated Lodge.

II. PROCEDURESACCIDENT PREVENTION MANAGERAccountability is crucial in a Loss Prevention Program:

1. Designate an Accident Prevention Manager as provided in 12 .070 of the Statutes of the Order . It will be his job to recognize hazards and recommend corrective procedures . Additional deputies may be appointed who have knowledge in the safety area . Good candidates would be Lodge members who are policemen, firemen or some other occupation dealing with safety practices .

2. The Accident Prevention Manager should conduct regular inspections of all areas of the Lodge . The Self-Inspection Checklist (see p. 18) will aid him in his inspections .

3. The Accident Prevention Manager should also thoroughly investigate any accident or loss which occurs to see what can be done to prevent a recurrence .

4. The Accident Prevention Manager should utilize the Accident Prevention Manual prepared by Grand Lodge in addition to the safety data contained in this booklet .

SELF-INSPECTION CHECKLISTA Self-Inspection Checklist is enclosed: (See Page 18) 1. Use it immediately to identify any hazards which now exist . 2. Act to correct or eliminate the hazards . 3. Review the Checklist each quarter to be sure that new hazards have not been created .

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I. Access Roads, Walkways, Parking Areas YES NO 1. Free of debris, cracks, broken paving _________ 2. Different elevations between adjacent walkways provided with guards or well marked _________ 3.Walkwaysflat,well-drained,withoutholes _________ 4. Fences & barricades secured & in good condition _________ 5. Pathways & parking areas well lighted _________ 6. Walkways have safe clearance from motorized equipment _________ 7. Signs indicating “Park at your own risk” _________

II. Stairs & Ramps 1. Standard stair rails or handrails provided on stairways with four or more stairs & ramps _________ 2. Handrails well secured with no sharp or rough parts _________ 3. Stairs tread & riser free of chips, cracks, unevenness _________ 4. Stairs treads & ramps slip resistant _________ 5. Stairways & ramps well lighted _________ 6. Do stairs have at least 6½ feet overhead clearance _________

III. Floor & Wall Openings 1. Large glass areas subject to human impact well marked _________ 2. Floor opening provided with guard rail or cover _________ 3.Gratetypecoversdesignednottoaffectfoottraffic _________ 4. Safe Floors Non-Skid _________

IV. Exiting & Egress 1. Emergency lighting provided in corridors & stairways _________ 2. All exits marked & properly illuminated _________ 3. All doors, passages, stairs that aren’t exits properly marked 4. All exits & passageways free of obstructions _________ 5.Areatleasttwomeansofegressprovidedfromupperfloors

V. Exit doors 1. All exit doors opening the direction of exit _________ 2. Cold storage room doors provided with inside release _________ 3. Doors opening into street provided with warnings or barriers to prevent stepping into path of vehicles _________

VI. Storage Areas 1. Storage areas clean, dry & free of refuse _________ 2. Entrance to areas locked while unattended _________ 3. Flammable & combustibles stored away from heating devices&openflames _________ 4. Trash & debris in metal covered containers & regularly removed _________

VII. Emergency & First Aid 1. Emergency numbers posted at each phone _________ 2. Employees instructed on reporting emergencies _________ 3. Employees instructed on use of portable extinguishers _________ 4. First Aid kits clean and fully stocked _________

VIII. Outdoor Fixtures & Playgrounds 1. Benches & tables free of cracks, slivers & broken parts _________ 2. Water fountains & taps in good repair without broken parts _________ 3. BBQ free of sharp edges or missing parts _________ 4. Playground equipment clean & in good repair _________

SELF-INSPECTIONCOMPLETED BY:______________________________________ TELEPHONE: (______)____________________ DATE:_______________Lodge Name & Number________________________________________________________________________________________________Street Address____________________________________________________________________________________________________City_______________________________________________ State__________________________________ Zip Code___________________

Note to District Deputies: Please access Self Inspection checklist at: http://www.elks.org/members/dds/selfinspection.cfm for filing online.

IX. Swimming Pool YES NO 1. Appropriate caution signs posted _________ 2. Proper enclosure to prevent falling into pool or access to children _________ 3. Glass cups & plates not allowed in pool area _________ 4. Remove Diving Board _________ 5.CertifiedLifeguardwhenpoolopen _________

X. Kitchen, Bar & Restaurant 1. Metal container with cover provided for greasy rags _________ 2. Knives stored in holders when not in use _________ 3. Electrical cords & plugs of appliances in good condition _________ 4. Food processing equipment properly guarded & in good repair _________ 5. Glass stored away from open ice storage & food storage areas _________ 6. Gas & beverage concentrate cylinders secured against tipping _________ 7.Drain&otherflooropeningscovered _________ 8. Non-skid mats provided in line of sinks, ice machine, range, etc. _________ 9. Are mats clean without grease or other build-up _________ 10.Foodsstoredoffthefloor _________ 11. Food covered & stored in refrigerator when not being prepared. Proper temperature maintained _________ 12.Hood&filtersoverrangeclean&notladenwithgrease _________ 13. Suppression system in hood inspected in last 6 months _________ 14. Chairs, Stools & Tables in Good Condition _________ 15.BoardofHealthcertifiedserverandinspection _________

XI. Restrooms, Locker Rooms, Showers & Saunas 1. Maintained dry, clean, sanitized & free of debris _________ 2. Well-illuminated, burned out bulbs promptly replaced _________ 3.Handtowel,soap,toiletpaper&sinkfixturessecured and in good repair _________ 4. Toilet stall & locker walls, doors & latches secure and in good repair _________ 5. Walking surfaces of non-skid materials _________ 6. Appropriate warning signs posted, i.e., “CAUTION — SLIPPERY WHEN WET” or “DO NOT USE OVER 15 MINUTES,” etc. _________

XII. Personal Protection Devices 1. Appropriate protective devices provided for chemicals on site such as respirators for gas leaks, gloves, goggles, etc. _________ 2. Compliance with “Right to Know” requirements where applicable _________

XIII. Protection Devices 1.Allautomaticfiresprinklersystemsupplyvalveswideopen_________ 2. All heat/smoke detection systems in operation _________ 3. Portable extinguishers serviced in last 12 months & tagged _________ 4. Pressures in appropriate range on gauge _________ 5. Extinguishers properly mounted at stations _________ 6. Extinguishers recharged, as required _________ 7. All sleeping quarters provided with smoke detectors unless provided with automatic sprinklers and carbon monoxide detectors _________

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LOSS PREVENTION MEASURESThe pages which follow deal with a variety of areas involved in a successful Loss Prevention Program . Although only Liability Insurance is afforded under this program sections on Fire Prevention and Crime Prevention have been included . Loss Prevention is a total effort and requires activities in all areas of operation .

REMEMBER: The time and effort spent on loss prevention will be more than compensated for in:

Accidents that do not haPPen! Losses you do not suffer! reduced per capita assessments!

III. ACCIDENT PREVENTIONPUBLIC SAFETY IS A PRIME CONSIDERATIONYour Lodge gains the respect of the entire community by exhibiting high regard for public safety . A constant attention to safety will make this respect continue to grow . In service to this objective, it is absolutely necessary that each Local Lodge strictly follow the procedure that no person approaching intoxication should be served an alcoholic beverage . [See Section VIII, page 29]Use of the Self-Inspection Checklist should help identify and reduce safety hazards . 1. LOOSE or BROKEN roof tiles, walking surfaces, planter edges, etc ., should be

replaced or repaired as soon as damage is discovered . 2. Include the REFUSE AREA in the parking lot cleaning duties . Make certain the

refuse area is kept clean to prevent insect and rodent infestation . 3. The DINING and MEETING AREAS demand constant cleaning . When these areas

are in use, spills should be swept up with a broom and “dry mopped .” All chairs, stools and tables should be inspected periodically for safety .

4. If MATS are used in front of doorways, care should be taken that the edges do not curl . Hard rubber mats with bound metal edges will lay more smoothly than woven fiber types .

5. BROKEN, CRACKED, or DAMAGED glassware, tables, chairs and benches should be removed from use until they can be repaired or replaced . All chairs, stool and tables should be inspected periodically for safety .

CHAIRS—STOOLS—TABLES in all areas must be inspected monthly and removed from service if repairs are needed . Commercial grade equipment should be used . A record of the date of purchase or receipt of such equipment should be maintained and the name of the manufacturer retained .

If an injury occurs related to equipment, remove the item from service but retain it for viewing by claims adjustors.

6. Store HIGH-CHAIRS away from traffic areas, and if damaged, remove them until repaired .

7. STAIR AND FLOOR coverings should be a taut, nonslip type and not too soft or heavily padded . A definite contrast in colors between floor surfaces, such as from carpet to linoleum, calls attention to tripping/stumbling hazards . Any difference in elevation requiring a step up or down should be clearly marked and lighted . Make sure there is adequate lighting on ramps and stairs .

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8. HANDRAILS and RAILINGS, installed and in good repair, are a requirement on stairs, ramps and mezzanines . Midrails and toe-boards prevent children and stock from falling through .

9. DOORS of safety glass, marked with Elks emblem decals at eye level, will prevent painful and sometimes serious physical injury . Persons colliding with glass doors can be further prevented by posting “in” and “out” signs .

10. EXITS should be visibly marked, lighted, unlocked and operational during business hours .

11. PARKING LOTS have been sites of numerous accidents; a well-illuminated lot, with no cracks or pot holes is basic . Snow and ice should be removed to prevent slipping and falling . Bumpers, parking dividing strips and islands will be visible if they are painted contrasting colors . A hazard-free parking area requires regular inspections and quick, corrective action when problems are found .

12. All WALKWAYS should be clearly marked . As with parking lots, snow and ice must be removed . Frequent inspection is necessary .

13. OUTDOOR FIXTURES and PLAYGROUNDS need to be free of defects which cause injuries . In addition to the quarterly Self-Inspection, the area should be visually checked weekly .

14. SWIMMING POOLS can be the sites of deadly accidents . Pay constant attention to the pool area, the activity in and about the pool, and the Self-Inspection items . This area should visually be checked constantly when in use . Make sure the proper life saving devices are present . Don’t allow horseplay . It is strongly suggested that diving boards be removed from all pools. It is also strongly recommended that all pools, when open, have trained lifeguards.

15. REST ROOMS and LOCKER ROOMS are the sites of many accidents . They need to be checked constantly for wet floors and other slip and fall hazards . Lighting level and items found in the Self-Inspection Checklist should also be checked .

16. DANCE FLOORS can be sites of many accidents: • Elevation changes such as ramps, floors and stairs along with changes in floor

covering can cause trips and falls . Contrasting color or lighting should be used to highlight elevation and floor covering changes .

• Receptacles also cause trip and fall accidents . These receptacles should be properly covered .

• Chairs and tables should be properly placed so they are not too close to the dance floor.

• Spilled liquid should be cleaned up immediately .

• Extension cords should be taped down or properly secured to prevent trips and falls .

• Floor waxed surfaces should be monitored for safety . Extra slippery surfaces should be re-waxed . (Proper wax should always be used.)

• Portable dance floors should be monitored for condition and repairs made as necessary.

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IV. SAFETYThe safety of members, guests and employees is important . You should establish a basic set of rules for everyone to follow . Members, guests and employees will only consider safety of prime importance if you demonstrate commitment first .

The Accident Prevention Manager should identify hazards and assure that preventive safeguards, adequate personal protection and guarding are provided .

1. SPRAINS and STRAINS resulting from improper lifting (i.e., lifting of heavy, bulky items, or from incorrect use of material handling equipment), can account for injuries . Stress correct lifting techniques and post guidelines in conspicuous areas . Review lifting situations which cause repeated injuries and develop new approaches . This may include reviewing job procedures currently used and eliminating a step such as twisting motion which could cause back injuries . You may find material handling equipment is necessary .

2. SLIP and FALL accidents frequently result from spillage, debris and cluttered passageways . Insist on good housekeeping .

3. ELECTRIC SHOCK can result in serious, sometimes fatal accidents . Keep all electrical panel boards, boxes, cabinets and switch enclosures covered to prevent contact with live parts . Repair or replace broken or missing box covers, face-plates, plugs, grounding prongs and frayed cords .

4. Severe BURNS can result from people coming into contact with grills and fryers .

5. FLOORS should be maintained in good condition; they should not have broken tiles, cracked or curled mat edges .

6. PROPER STORAGE OF STOCK will minimize accidents . Boxes and carts must never block exits, fire extinguishers or electrical breaker panels .

7. MEMBERS, GUESTS and EMPLOYEES should be trained in the use of all machines and equipment they will be operating . Continue supervision until you determine they have learned their tasks . Do not permit horseplay .

8. The RECEIVING AREA should be designed for safe, efficient delivery of stock . Store and secure loading ramps, hand trucks, and belt and roller conveyors between deliveries . Use only physically able employees to set up ramps . Safe exiting is assured with the following:

• Ramps from basements to first floor exits should not be wider than half the width of the basement stairs .

• Do not allow walking on ramps .

9. Perform CLEANUP operations in an orderly, complete and unhurried manner .

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V. FIRE PREVENTION 1. DEFECTIVE WIRING and misuse of electrical equipment are major causes of

fires . A licensed electrician should determine that all wiring complies with local codes . Frequent fuse/circuit breaker burnout may indicate a short . Avoid over-loading electrical sockets with too many plugs . Eliminate temporary wiring that hangs over nails or sharp metal edges, lays under carpeting, on door sills or other areas of unusual wear . Keep lights and heat-producing units clear of combustibles . Any coffee urns and hot plates must be U .L . approved . Motors should be clean and maintained regularly .

2. SMOKING ranks after electricity as one of the main causes of fire . Make certain “No Smoking” areas are posted . This will help your members and employees follow the rules . Provide an adequate number of ashtrays in smoking areas .

3. IMPROPER STORAGE is a frequent contributing cause to large-loss fires . Subdivide your stock appropriately, piling boxes not higher than fire safety regulations permit, and away from windows and doors . Maintain clear aisles .

4. FLAMMABLE and COMBUSTIBLE LIQUIDS are a frequent cause of fire . Insist upon storage in U .L . listed containers and on the careful handling and use of gasoline, solvents, paints and chemicals by your members and employees . These materials should be kept away from any heat sources . Oily rags must be stored in covered metal cans to prevent spontaneous ignition or removed from the premises .

5. DEBRIS accumulation, whether combustible or not, will impede efficient operations and obstruct fire fighters . Schedule a cleanup day, with provisions made for the frequent removal and safe storage of trash .

6. FIRE EXTINGUISHERS are very effective in containing a small or “just-beginning” fire . Training in the use of fire extinguishers is important . The presence of oil or grease makes water useless in fighting a fire; it can actually cause a fire to spread . Extinguishers marked BC or ABC are effective against most kitchen fires . Have all extinguishers checked annually by a servicing company . Re-charge immediately after use or when loss of pressure is detected .

7. The AUTOMATIC EXTINGUISHING SYSTEM which protects your grill and deep fat fryers, should a fire occur, needs servicing twice a year . Exhaust ducts should be cleaned annually .

8. If you have an AUTOMATIC SPRINKLING SYSTEM, it is effective only when these criteria are met:

• Water supply valves are open . • An electrical water flow alarm switch is installed and operating . • Periodic maintenance and inspection, with testing of water supply, valves,

and system piping, carried out . 9. An ARSON threat exists in two major areas: • The rest rooms — remove trash several times daily . • Outside refuse areas — keep dumpster lids closed at all times . 10. A LIGHTED CIGARETTE may be thrown into a trash can inside your building .

If the fire is discovered quickly, clear members away before using an extinguisher . Call the fire department, even if you think the fire is out . Many times smoldering embers may go unnoticed, flaring up hours later .

Regular self-inspection and training will help prevent fires and prepare the Lodge to deal with fire if it occurs.

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VI. CRIME PREVENTIONBurglaries, robberies and thefts are carried out as intentional acts by people who are determined to succeed. For this reason, the prevention of such losses requires more care and effort than the prevention of accidental losses such as fires or injuries to employees or guests. While no two Lodges have identical physical and operating characteristics, the following “Crime Prevention Principles” should be instituted.

PREMISES PROTECTION 1. Doors and locks should be “burglar resistant .” Consult your local fire and police

department for applicable codes . 2. Exterior lights should remain on all night, especially those illuminating doorways . 3. The safe should be easily seen from the exterior, with lights on all night in its vicinity . 4. Lodges in isolated areas (where burglars may work without interruption) should

consider a burglar alarm system, with a signal going to the nearest police station . 5. The police should be asked to patrol your areas . If the police are unable to do that,

you might consider a private patrol service .

HANDLING OF MONEY & SECURITIES 1. Be aware of your Lodge safe’s limitation . Most safes provide limited protection and

will not deter a burglar . 2. Only enough money to start operations the following day should be left in the Lodge

at night . The balance should be taken to the bank at the end of each day, using the bank’s night depository if necessary . In some areas a police escort is available for the asking .

3. In the absence of a police escort, a trip to the bank or the locking up of the Lodge at night should be done by two people .

4. All receipts should be recorded as soon as possible . If money is collected for some purpose and simply put in a box temporarily, it will be very difficult to prove the amount of loss . Keep receipts separate .

5. All checks should be endorsed “For Deposit Only” upon receipt .

INTERNAL SECURITY 1. The safe combination should only be known by the two or three people who must know .

It should be memorized and written down only for placement in a safety deposit box . The combination should be changed whenever the people handling the money change .

2. The workings of the burglar alarm system, procedures for going to bank, etc ., should be known only by those who need that information .

3. The Lodge’s daily receipts or the amount of money in the cash drawer or safe are not matters for general discussion or information .

4. Cash handling procedures should be formalized so that certain people are responsible for cash while it is in the Lodge . The circumstances and facts of their responsibility should be clearly identified .

5. People who are basically honest may succumb to the temptation of apparent easy access to money . Your procedure of double checks is intended to eliminate those temptations .

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VII. FIRST AID and CPRSCOPEThis Section covers suggested requirements and responsibilities for training people in first aid techniques and cardiopulmonary resuscitation (CPR) .

PURPOSEThe intent is to develop and maintain a team of volunteer first aiders qualified to give immediate help in an emergency situation .

RESPONSIBILITY of the ACCIDENT PREVENTION MANAGERIt should be the responsibility of the Accident Prevention Manager to see that: 1. A team of people are trained to render first aid in an emergency situation . 2. CPR and first aid training classes are organized, scheduled and taught by certified

instructors . 3. Records are maintained on qualified first aiders . 4. Volunteer candidates are recruited for training and retraining . 5. All injuries are investigated and medical treatment is continued .

COURSES ACCEPTABLE: 1. CPR (Cardiopulmonary Resuscitation) A. The American Heart Association’s course consists of eight hours of training followed

by a test which, when passed, warrants CPR certification as a basic cardiac life support provider . The American Heart Association’s certification is valid for one year, and retraining for CPR certification is required every three years . [It is Not Recommended that Lodges obtain defibrillators — See page 52 of Accident/Claim Prevention Manual, 5th Edition.]

B. The Red Cross CPR course consists of twelve hours of training followed by a test which, when passed, also warrants CPR certification as a basic cardiac life support provider . The first Red Cross certification is valid for one year after which retraining is then required . Subsequent Red Cross CPR certification is valid for three years before retraining is required .

2. FIRST AID A. Red Cross “Standard Multimedia First Aid Course .” This covers treatment of cuts,

burns, choking, scalds, etc . It consists of eight hours training followed by a test, which when passed then warrants first aid certification which is valid for three years . When the certification period runs out the course must then be repeated .

B. Red Cross “Standard First Aid and Personal Safety .” This consists of approximately twenty hours of training .

C. Red Cross “Advanced First Aid and Emergency Care .” This consists of approximately fifty-two hours of training .

D. “U .S . Department of Transportation Emergency Medical Technician Course .” This consists of approximately eighty-one hours of training .

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INSTRUCTOR QUALIFICATIONSInstructors shall be certified by the Red Cross or American Heart Association in the following skills: 1. First Aid Red Cross “Standard First Aid and Personal Safety Instructor” or 2. Red Cross “Standard Multimedia First-Aid” or 3. Instructor Red Cross “Advanced First Aid and Emergency Care Instructor” or 4. Red Cross “CPR Basic Life Support Instructor” or 5. American Heart Association “CPR Basic Life Instructor .” (An instructor of “Advanced

First Aid and Emergency Care” is also qualified to teach “Standard First Aid and Personal Safety.”)

RECOMMENDATIONS 1. First Aid Team It is suggested that every Lodge develop a team of people trained to render first aid

in an emergency situation . Prime candidates to receive training are people who express a desire or show interest .

2. Minimum Training Requirements CPR and Multimedia First Aid, Standard First Aid and Personal Safety or equivalent . 3. Retraining CPR refresher courses should be provided on an annual basis, regardless of certification

period . 4. Training on Company Time Only CPR, the Red Cross “Standard Multimedia First Aid Course,” or “Standard

First Aid and Personal Safety,” should be taught . 5. Attrition Rate of First Aiders Attrition factors must be planned for by training ten to twenty percent more people

than the team requires and as soon as the excess starts to diminish, schedule more training .

— FIRST AID —GENERAL PROCEDURESPrompt action must be taken in cases of serious injury or sudden illness, while help is being summoned . First Aid should be administered in the following order: 1. Keep the injured person lying down, with his head level with his body . 2. Look for any life threatening conditions such as serious bleeding, stoppage of breathing,

shock, evidence of poisoning and burns, and treat if possible . 3. Keep the injured person warm to conserve his body temperature . 4. Do not move a seriously injured person unless it is necessary to avoid additional

injury . 5. Do not give water or other liquids to an unconscious or semiconscious person . 6. Make the injured as comfortable as possible . Minimize any discussion of severity

of his injuries . 7. Call for medical assistance as soon as possible .

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EXAMPLES OFEMERGENCY FIRST AID PROCEDURES

Kind of Emergency & Examples General First Aid Steps_____________________

RESCUE: Call for medical assistance immediately .

CPR (Artificial Resuscitation) A. Airway, Open airway (Head Tilt — Chin Lift) B. Breathing . Check breathing . If not breathing, give

2 full breaths . C. Circulation . Check pulse . If no pulse, begin cardiac

compression . 15 Compressions / 2 Ventilations . Make sure medical assistance is on the way .

Heart Attack Treat for shock (see below) A. Keep person quiet, raise head and prop him up

if necessary to restore breathing . B. Administer oxygen, if available .

Choking Use Heimlich Maneuver A. Stand behind the victim . B. Hold your arms around his waist near

diaphragm . C. Hold your own wrists firmly and squeeze hard . D. If the victim has collapsed, place your hands on

top of each other near the diaphragm and push toward the head .

SEVERE INJURIES: Call for medical assistance immediately .

Hemorrhage A. Stop bleeding by using direct pressure – Note (1) .Electrical shock B. Treat for shock, if necessary .Chemical burns C. Keep patient lying down and calm .Thermal burns D. Clean and dress wounds if possible .Eye Injuries – Note (1) E. Flush chemical away from eye or skin .Fracture – Note (2)

Note (1): Do not apply direct pressure to eyeball; use cold compress and seek medical assistance immediately .

Note (2): Keep joint straight and apply splint which extends above and below the break .

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EXAMPLES OFEMERGENCY FIRST AID PROCEDURES (Continued)

Kind of Emergency & Examples General First Aid Steps_____________________

TREATMENT FOR SHOCK: Call for medical assistance immediately .

A. Give artificial resuscitation if necessary . B. Keep person lying down; head level with body

and turned . C. Elevate feet if not painful . D. Raise head and chest if there is difficulty

breathing . E. Keep person warm with light blanket . F. Give sips of water, if conscious and there is no

abdominal pain .

MINOR INJURIES: Get medical attention if puncture wound is deep or injury seems complicated .

Abrasions, cuts, scratches A. Wash and rinse wounds .Minor burns B. Remove foreign material, if possible .Head injuries C. Apply antiseptic and dressing .Chest injuries D. Treat for shock, if necessary .Nosebleeds E. Apply cold compresses for nosebleeds, sprains,Puncture wounds and mild injuries .

Sprains F. If teeth are dislodged, wrap in moist gauze andFainting take to dentist .

Strains Minor falls

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EXAMPLES OFCHOKING TREATMENT PROCEDURES

Learn to recognize when a person is choking . The first sign is a person suddenly becoming quiet with a look of alarm on his face . He may clutch at the throat or chest and attempt to rise . Seconds later he will start to turn blue and lose consciousness . When a piece of food lodges in the throat so that it prevents breathing, the victim has less than four minutes before death from asphyxiation . Treatment must be immediate.

There are two methods of saving a choking victim.

IF THE PERSON IS CONSCIOUS: 1. If the victim can speak, cough or breathe, don’t interfere . 2. If the victim can’t speak, give four quick blows on the back to dislodge the foreign

object . 3. If unsuccessful, make a fist with one hand, clasp fist with the other hand, and

give a quick upward thrust (Heimlich Maneuver) four times between the navel and rib cage .

IF THE PERSON IS UNCONSCIOUS:First try to restore breathing using the mouth-to-mouth technique:Lift the neck and push the head back . Pinch the nostrils shut, keeping the neck up . Make a tight seal with your mouth around the victim’s mouth and blow into the victim’s mouth .If the chest does not rise, treat for choking as follows: 1. Roll the victim on his side, bracing his chest against your knee . Strike him

sharply, several times in rapid succession, between the shoulder blades with the heel of your hand .

2. Remove any foreign matter from the mouth and begin mouth-to-mouth breathing . 3. If unsuccessful, kneel close beside the victim’s hips and place the heel of one hand

on the center of the abdomen, slightly above the navel and below the rib cage . Place your free hand on top of the other .

4. Press in toward the center with a quick upward thrust . Do not press to either side . Repeat several times if necessary .

5. If vomiting occurs, quickly turn the victim’s head to one side . Clear the mouth and begin the mouth-to-mouth breathing .

Be prepared! Learn the proper techniques for treatment of CHOKING and CPR (Cardiopulmonary Resuscitation) by attending classes given by the RED CROSS, HOSPITAL or FIRE DEPARTMENT.

A safety poster entitled, “How to save a Choking Victim” is available from the American Red Cross .

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VIII. ALCOHOL SAFETYGuidelines for Service of Alcoholic Beverages

It is the objective of the Lodge to create a safe and congenial environment for its members . Lodge facilities are not places of public accommodations and strict compliance with this rule must be maintained . Each Lodge has the right to refuse service to any member or any guest of a member .The most important contribution that the Accident Prevention Manager can accomplish for his Lodge is to obtain compliance with these procedures . Liquor claims are few in number but cost the Order many times more than any other type of claim .In every case, the following rules must be followed by any employee, volunteer or member who serves alcoholic beverages .

I. All state and local laws must be complied with . (It is the duty of Lodge management and any server to be aware of these requirements.)

II. Under no circumstances may minors be served . (It is the duty of the server in any case where there is doubt of age to demand age identification – better to err on the side of compliance than to make a mistake.)

III. Under no circumstances may alcoholic beverages be served to anyone who is intoxicated, appears to be intoxicated or is approaching intoxication . And it is the duty of the server to operate under the following procedures (the bartender for bar service and the waiter for table service.)

1. Observe all patrons to detect signs of intoxication . 2. Be aware of the number of drinks a patron has consumed . 3. Inform relieving personnel of the status of patrons at the time of a

shift change . 4. Report to management when a patron shows signs of intoxication or

impending intoxication and a termination of service is required . If there is no manager or person of authority in the Lodge, the server must cut off the service . The termination of service must always be done in a polite manner but when required, it must be done .

5. Each Lodge if possible should establish a procedure so that someone in authority can act to cut off service . It should be made clear to all members that service of alcoholic beverages is a privilege not a right .

6. All requirements of service apply to attendees at parties (weddings, anniversaries, birthdays, etc .) sponsored by a member whether such service is provided by Lodge personnel or by contracted bartenders . It is the duty of Lodge management to demand compliance with Lodge rules .

7. In judging whether an individual is intoxicated or not the server should be aware that such an evaluation is a function of body weight, time and amount of alcohol consumption . The following guidelines may be helpful in observing patrons .

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ALCOHOL AFFECTS THE BODY IN THE FOLLOWING SEQUENCE: Inhibitions are relaxed! Judgment is impaired! Reactions get slower! Coordination decreases markedly!

If the following types of behavior are observed, be alert that you may need to take action .First Stage — Inhibitions • Being overly friendly • Speaking loudly • Annoying other customers • Acting “big” • Changing from loud to quiet or vice-versa

Second Stage — Judgment • Unjustified complaints about service • Changing purchase behavior • Using foul language • Arguing • Trying to buy items for strangers or for you • Being careless with money • Being belligerent • Making irrational statements

Third Stage — Reactions • Lighting more than one cigarette at a time • Unable to light cigarette • Eyes glassy • Eyes not focused • Loss of train of thought • Slurred speech

Fourth Stage — Coordination • Unable to pick up change • Drops package • Can’t find pocket to put money away • Unable to walk straight • Bumps into things • Stumbling • Swaying, falling • Drowsy

Occasionally these symptoms will be caused by a physical or emotional condition or medication unrelated to alcohol, but for your sake and the patron’s, it’s better to be safe than sorry.

MAJOR TOPICAL INDEX LIABILITY INSURANCE PROGRAM

Accident Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-17, 19-23

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Alcohol Safety/Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29-30

Claims Report Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14-15

Claim Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2, 13-15

Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2, 4-7, 9

Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-28

Indemnification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-11

Insureds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-12

Legal Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-12

Limits of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4, 9

Non-Owned Autos/Hired Cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4, 6

Self-Inspection Checklist (required by District Deputy) . . . . . . . . . . . . . . . . . . . . .18

Code No. 513000 — Rev. 3/2013