The URL can be used to link to this page

Home My WebLink AboutInsurance - BOCCCRUM & FORSTER CRUM & FORSTER SPECIALTY INSURANCE COMPANY ENVIRONMENTAL QUOTE 1 DATE OF PROPOSAL: 06/26/2025 Item 1. 1 NAMED INSURED & ADDRESS: GRANT COUNTY 33 C Sti-eet NW Ephrata tf-A- 988.23 PRODUCER NAME & ADDRESS: ENVIRONMENTAL RISK MANAGERS, INC. 4668 Division St Hofine,,Iflchi 00 49335 -00 FORM OF BUSINESS: Governmental Entiql-,'Public Prorty .]gan PRODUCER CODE: 9473 Item 2. PROPOSED POLICY PERIOD: A_ 071107/2025 to 07/070016 L.I'&).:O I a.m. Standard Time at the Named Insured's address stated above. Item 3. LIMITS OF INSURANCE: Each Confirmed Release Limit: 1 ,00011000 Polk Y Aaorre-Lmte Limit: Q - $1,000,000 Defense Expense Agorrea i i ,at Limit: e S1.1000.000 Item 4. TDEDUCTIBLE/SELF-I?' SURED RETENTION: - ------ -- See Tank Schedule Item 5. TRETROACTIVE DATES: See Tank Schedule Item. 6. PREMIUM: Policy Premium: 4 7 Additional Insured Premium: $0, TRIPRA Premium: $274 Total Policy Premium: $25, 7 50 Minimum Earned Premium: 25% Minimum Policy Premium: 100% Item 7. AUDIT PERIOD: Not Subject to Audit 1Basis: Units: 2 UST's .8 ASTs ]Rate: Flat Att rates are oase(I on the revenue oasis shown ar)ove anct no (tecluctions of any kind are allowed. All premiums applicable to additional coverage(s) as required during the policy period will be invoiced separately and will. not apply toward the minimum earned or estimated coverages) Z:� policy premium. The broker is responsible for filing all affidavits and paying all fees, if applicable. The insured shall be responsible for applying any and all applicable taxes and surcharges. RECEIVED JUL 14 2025 IM�►�� - (`l- L l � � sk � S� �� C0 ter i��.-�r II.JvoM. GRANT COUNTY COMMISSIONERS X CRUM&FORSTER FORMS AND ENDORSEMENTS CFSTP 00 001 10 16 COMMERCIAL STORAGE TANK LIABILITY POLICY DECLARATIONS EN002-02 I I SCIJEDULE OF FORMS AND ENDORSEMENTS IL P 00 10 1. 04 u.s.TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC"') AI)VISORY NOTICE TO POLICY HOLDERS CS 0�00 10 1 2) 1 C&F SPECIALTY SIGNATURE PAGE EN0004-0-52 I CLAIMS REPORTING EN0005-1017 SERVICE OF PROCESS CLAUSE EN0006 01 0 Policyholder Disclosure Notice cif Terrorism Insurance Coverage ENOO I I - 10 14 PRIVACY NOTICE EN0050-022-2 EMERGENCY RESPONSE FIOTLINE E N 0 0 5 22 - 02 222 NOTICE OF LOSS ALL CFSTP 00 000 01. 1 STORAGE TAW POLL POLICY CFSTP 00 0022 01 211 DEDUCTIBLE ENDORSEMENT CFSTP 00 -50 1 10 15 MANDATORY NOTICE OF VOLUNTARY REMOVAL OR REPLACEMENTCAI" UNDERGROUND STORAGE TANKS SYSTEM CFSTP 00 -522'.5 05 16 COVERED STORAGE TANK COVERAGE ENDORSEMENT CFSTP 00 546 10 1.3" LOADING OR UNLOADING COVERAGE ENDORSEMENT CFSTP FR. CERT-FED FENTANCIA.L RESPONSIBILITY CERTIFICATE OF 1NStJRANCE - FED Ts proposal is based on the insurance Caffi.er's most recent pollcy fon-ns and endorsements and is sttt�ject to all ten--ns avid cond-11i.ons of such forms and endorsements, If you wMild fik-e to review a copy, p1lease let nie know and I would. be pleased to send youa specimen fonn. WARRANTI. S/R 'EXIENTS ,-,-E EQUIREV. i Please be advised that coverage has been proposed conditional upon receipt, review, verification and approival of the following items: Subjectivit%- Frame Signed Terrorism Rejection / Selection Form Prior to Binding Complete.d Surplus Tines Tax Form Signed and dated CF STP AppliCation listing the correct tank schedUle in Seci iton IV, Prior to Binding 124 Enterpirse St, Recer-4,30 Day Spill Bucket & Sump Walkthrough ins I � i I L , I IL 1. t:11 11 i Prior to Binding This proposal is valid until the pollee effective date or 30 days from.. the date of this letter, whichever is sooner. After expiration. all terms and conditions of this proposal must be re-evaluated by Crum & Forster Specialty Insurance Cornpany. Please note that this proposal is based upon terms and conditions that Crum & Forster Specialty Insurance Company is willing to offer and not the terms and conditions whivch were requested. It is your responsibi.11tv to review these terms and conditions prior to presenting this proposal. Crum & Forster Specialty Insurance Company reserves the right to modlR!, change or cancel and- car all terns of this proposal at anytime without notice. I zn CRUM&FORSTER A �iw -coowry ---- ------------- Loc Address citV Mate Zip Tank AST Year Ca �-,a c. i �q - Contents fly: d L i c t -R e t r - oactive Code IfUST Installed Date I 124 Enterprise St. SE Ephrata WA 98823 t UST 1996 9,730 Gasoline S25,000 7 '/7 ' "2006 ��,) 1 11.4 Enterprise St. SE 'Ephrata WA 98823 UST 1996 9,730 Diesel S2 5,000 71ir T, 006 2 0 1 A000 '803 Neva Lake Road Ephrata WAI AST . 9881" 40 Diesel S�7/7/ 016 3803 Neva Lake Road Ephrata WA 98823 d 2) 0 t 2) AST 1000 Gasoline S51000 7 7'�') 0 16 '80" Neva Lake Road Ephrata WA 9 8 823 -2 b AS-)01-) -MO Waste Coil �5,000 il 7171/2016 7 2.3.2 Chelan St. Hartline WA 99135 1. a AST 1999 8,000 Diesel S-SMO 717/2016 232 Chelan St. flartline WA 99135 lb AST 1999 4.000 Gasoline S5,000 7117/2 6 Nivilattawa 344 [a AST 1999 MO Gasoline 4 24378 Broadwav St. WA 99�) S5,000 7/72 0 16 4 24378 Broad wav St. Mattawa WA 9344 1, b AST 1999 4,000 Diesel S5,000 7/7,2016 5 12 171 Wheeler Rd. 'Moses Lake WA 988 1 t AST 2009 10,000 Gasoline S '000 7 7 /2 0 16 5 12 171 Wheeler R& Moses Lake WA 9 8 8 37 AST 2009 10,000 Diesel $5,000 1/1 17 ?00 8,000 Diesel $5.000 7/7/2016 6 47 18 R-d P NW QUincy WA, 98848 la AST 6 4718 Rd P NW Quincy WA 98848 lb AST 12 () 0 4AM 0 Gasoline s5O 7/71"2016 7 11766 Road E SW Roval City WA 9 9 357 1 a AST , 2) 0 8'.000 Diesel 7/7/20 t 6, 000 I' J760'* Road E SW Roval Cltv WA 99-33557 111 AS 2003 4,000 Gasoline S5.000 7/7 0 16 TERRORISM RISK INSURANCE ACT YOU ARE HEREBY NOTIFIED THAT UNDER THE TERRORISM RISK INSURANCE ACT, AS AMENDED, YOU HAVE A RIGHT TO PURCHASE INSURANCE COVERAGE FOR LOSSES RESULTING FROM ACTS OF TERRORISM, AS DEFINED IN SECTION 1020) OF THE ACT.- THE TERM 'ACT OF TERRORISM" 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 TERRORISMTO BE A VIOL -ENT ACT OR AN ACT THAT IS DANGEROUS TO HUMAN LIFE, PROPERTY, OR INFRASTRUCTURETO 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, 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 GOVERN MENTU NDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY r,,.'ONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS, UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 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 THE LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, 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 $1010 BILLION, IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED - IN ACCORDANCE WITH THE ACT, YOU MUST CHOOSE TO ELECT OR REJECT COVERAGE FOR "CERTIFIED ACTS OF TERRORISM"' BELOW: ------------ I hereby elect to Purchase certified acts of terrorism coverage for a premium of _J2-t4 ------ ----- - ----- I hereby decline to pucov nchase terrorism erage for certified acts of terrorism. I understand that I will have no coverage for losses resultinq from certified acts of terrorism. P*k4A@fd'e'_r1'APPlicaW St-gl-lat—u'r- LRob Jones Print Na a T-1 4/2025 Date EN0006 - 0120 7ti�/2eaS ��I`i�z02.� GRANT COUNTY gamed Insuredit'Firm 33 C Street MAI, Ephrata, WA, 98823 Mailing Address QuotelPolicy Numbber