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HomeMy WebLinkAboutInsurance - BOCCFREBERG ENVIRONMENTAL, INC. INSURANCE PROGRAM MANAGERS DATE: 9/912021 Environmental Impairment Liability Page 5of8 Admiral Insurance Company POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Grant County PO Box 37 Ephrata, WA 98823 You are hereby notified that under the Terrorism Risk Insurance Act, as amended, (the "Act"), you have a right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term "act of terrorism's means any act that is certified by the Secretary of the Treasury ---in consultation with the Secretary of Homeland Security, and the Attorney General of the United States ---to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct: of the United States Government by coercion. Coverage under your policy may be affected as follows: YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR. LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85% THROUGH 2015; 84% BEGINNING ON JANUARY 1, 2018; 83% BEGINNING ON JANAUARY 11 2017; 82% BEGINNING ON JANUARY 1, 2018; 81% BEGINNING ON JANUARY 1, 2013 AND 80% BEGINNING ON JANUARY 1, 2020 OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE ACT, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED. Acceptance or Rejection of Terrorism Insurance Coverage © 2015 National Association of Insurance Commissioners I hereby elect to purchase terrorism coverage, subject to the limitations of the Act, for acts of terrorism as defined in the Act, fora prospective premium of 1%Q subject to a minimum of $250. I hereby decline to purchase terrorism coverage for certified acts of terrorism, I understand that I will have no coverage for losses resultin from certified acts of terrorism. © 2015 National Association of Insurance Commissioners Environmental Impairment Liability Page 6 of 8 Possibility Of Additional Or Return Premium. The premium for certified acts of terrorism coverage is calculated based in part on the federal participation in payment of terrorism losses as set forth in the Act. The federal program established by the Act is scheduled to terminate at the end of December 31, 2020 unless extended by the federal government. If the federal program terminates or if the level or terms of federal participation change, the estimated premium shown above may not be appropriate. . If the policy contains a Conditional Exclusion, continuation of the coverage for certified acts of terrorism, or termination of such coverage, will be determined upon disposition of the federal program, subject to the terms and conditions of the Conditional Exclusion. If the policy does not contain a Conditional Exclusion, coverage for certified acts of terrorism will continue. In either case, when disposition of the federal program is determined, we will recalculate the premium shown above and will charge additional premium or refund excess premium, if indicated. If we ou tif of an ad ffiona premium charge, the additional premium will be due as specified in such notice. Cindy Carter,, Policyholder YAppricti-s,-5ignalur&) Print Name Chair , Board of County- Commissioners Title Date NOTE TO PRODUCER: This form must be completed and signed by the Insured/Applicant and returned to FEI in order to bind. 0 2015 National Association of Insurance Commissioners a 'Oft luuoted Coverages EnVironmental Impairment Liability Admiral Insurance Company (A.M. Best Rating A+XV) Applicant: Grant County Mailling Address: PO Box 37, Ephrata, WA 98823 Form of Business: CountyGovern m*ent (PLEASE NOTE — If the above listing of the Applicant=s complete name and address are not shown correctly, please verify,the correct information upon binding) anin nvironment m s oa,od, Ith X Coverage A. Onsite Cleanup Costs X Coverage B. Offsit6 Qe'anuo Q Ve'osis Cama - . X Cdra'ge' C. Pro pio-irty Da-maq . e or Bodily I njur t TParties y to i a e E, 'n­nt F "ao,-r e -ma Exclusion of Terrorism JA1001 1016 Signature Page EIL-1001-0316 Env[ronhiental Im'pa.irm.ont Liabilt`ty - Claims MadQ Form ECC -327-0917 Minimum Premium Endorsement PN -0002-1215 Trade or Economic Sanctions Endorsement EIL-1093-0316 Mold-Leqionelia Exclusion Endorsement ECC -322-0520 CLAIMS NOTICE DOCUMENT PN -0001 00107 OFAC EIL 1029-0120 No Coverage for Electronic Data EIL-1031-0316 Coverage D Transportation Pollution Liability - rd Party Carriers Re'troacti*ve'- Date: 10/10/2Q19; SIR: $10,0Q0 EIL-1 135-0316 Coverage E Transportation Pollution Liability - First Party —RetTo�icti.veD.ate,-1,0/10/��019- S1R:$t%OOO EIL-1096-0316 Covera'ge F Non Owhed Locations Coverage Endorsement Retroaetivo Date- 01.9. SIR. 0 EIL-1003-0316 Additional Insured Endorsement State of Washington, Department of Natura.1 R* esources 713 Bowers Road, EllensbuEg,WA, 989.1.6 EIL--1085-0316 Named Insured Endorsement Grant County Pubbe Works PO Box 37, Ephrata, WA 98823 EIL-1 106-0919 Coverage A Onsite Cleanup Costs Limited to Sudden and Unintended Discharge All Scheduled Locations, ECC -1326-0621 Service of Suit Washington Notice State Surplus Lines Notice Attachment The following endorsements apply depending upon whether the Applicant/Insured declines or accepts, TMA Coverage 06-c"'064. TRIA-Co' v -a' r-'aae, CG 2190 0106 Exclusion of Terrorism A66' t TRIA overs.get P CG 21 71 01 15 Excl. of Terrorism Outside of US, Cap 2015 Disclosure TRIA Disclosure of Premium CG218401 15 Exclusion of Certified NBCA CG 2187 01 15 Exclusion Related to Expiration of TMA CG 21 91 01 06 Exclusion of NBCR Terrorism tw 6' add ss�qs) Of -thi4-p o e, insur jo POS -1 W L a ion eas6,Vern: _0 n s P1 0 re �s e, d�lrl Location 1 - Mattawa Drop Box Site - That portion of the NW A SWI /4 of Section 11 Township 14 North, Range 23 East, W.M., GRANT County, Washington, conta-'ining 4 - 5 acres, Mattawa, WA 99349 Regardless of the number of Coverage Parts or Coverages written under this policy or applicable to any one Claim or Pollution Condition, the Limits of Insurance shown below apply once for the entire policy, and not separately for each Covorage Part or Coverage, S, ed.s., an ftW Policy Fee: $250 Rate_*.----- Flat Ert'virome, 'n a M a W IM IrmentUa... n1h nsul ancez K000,000 Per Pollution Condition Limit $5001000 ,Aggregate Limit for All Pollution Con'ditions tw did Re iitk` D t 0 Ue I 0 d _"' Nble-'_ Ret t roaoive., a q: rm MUM 1 Year $9500 EIL $10,000 Per Pollution Condition SIR 10/1012019 2 Year $16,150 L.3Year-, 1 $21,850.. S, ed.s., an ftW Policy Fee: $250 Rate_*.----- Flat Admiral Insurance Company 11 [oil 9 r4i WE ARE REQUIRED THE TERRORISM RIS INSURANCE ACT TIA), AS REAUTHORIZED AND AMENDED, TO PROVIDE POLICYHOLDERS WITH A CLEAR. AND CONSPICUOUS DISCLOSURE OF THE PREMIUM WE ARE CHARGING FOR TERRORISM COVERAGE AND THE FEDERAL SHARE OF COMPENSATION FOR SUCH COVERAGE. THIS NOTICE MUST BE PROVIDED AT THE TIME OF OFFERy PURCHASE AND RENEWAL THE POLICY. WE HAVE PROVIDED YOU WITH A NOTICE THAT MEETS T THE ACT'S REQUIREMENTS. YOU ARE INSTRUCTED TO DELIVERA COPY OF THIS NOTICE TO OUR PROSPECTIVE INSURED WHEN YOU FORWARD OUR QUOTE. @ 2015 National Association of Insurance Commissioners