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Home My WebLink AboutAgreements/Contracts - BOCC (003)GRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: Risk Management REQUEST SUBMITTED BY. Blair Kok CONTACT PERSON ATTENDING ROUNDTABLE: Blair Kok CONFIDENTIAL INFORMATION: ❑YES *NO DATE: 6/25/26 PHONE: 754-2011 ext 4902 Agreement / Contract ❑AP Vouchers []Appointment / Reappointment ❑ARPA Related ❑ Bids / RFPs / Quotes Award ❑ Bid Opening Scheduled ❑ Boards / Committees ❑ Budget ❑ Computer Related ❑ County Code ❑ Emergency Purchase ❑ Employee Rel. ❑ Facilities Related ❑ Financial ❑ Funds ❑ Hearing ❑ Invoices / Purchase Orders []Grants — Fed/State/County ❑ Leases ❑ MOA / MOU ❑ Minutes ❑Ordinances ❑Out of State Travel ❑ Petty Cash ❑ Policies ❑ Proclamations -❑-Request for Purchase ❑ Resolution El Recommendation ❑Professional Serv/Consultant ❑Support Letter []Surplus Req. ❑Tax Levies ❑Thank You's ❑Tax Title Property ❑WSLCB M=lw Approval for the Risk Manager to sign insurance contracts with Crum & Foster for Storage Tank/Environmental which is an annual renewal for $6275.08. If necessary, was this document reviewed by accounting? ❑ YES 0 NO ❑ N/A If necessary, was this document reviewed by legal? ❑ YES ❑ NO 0 N/A DATE OF ACTION: 6 -30 ' o APPROVE: DENIED D1: fz, 63- D2: D3: DEFERRED OR CONTINUED TO: WITHDRAWN: 4/23/24 CRUM&FORSTER' CRUM & FORSTER SPECIALTY INSURANCE COMPANY ENVIRONMENTAL QUOTE DATE OF PROPOSAL: 06/24/2026 Item 1. NAMED INSURED & ADDRESS: GRANT COUNTY 33 C Street NW Ephrata, WA 98823 PRODUCER NAME & ADDRESS: ENVIRONMENTAL RISK MANAGERS, INC. 4668 Division St Moline, Michigan 49335-0000 FORM OF BUSINESS: Governmental Entity/Public Property PRODUCER CODE: 9473 Item 2. PROPOSED POLICY PERIOD: 07/07/2026 to 07/07/2027 12:01 a.m. Standard Time at the Named Insured's address stated above. Item 3. LIMITS OF INSURANCE: 1 Each Confirmed Release Limit: $1,0005000 Policy Aggregate Limit : $1,000,000 Defense Expense Aggregate Limit: $1,000,000 Item 4. DEDUCTIBLE/SELF-INSURED RETENTION: See Tank Schedule Item 5. IRETROACTIVE DATES: See Tank Schedule Item 6. PREMIUM: Policy Premium: $5,723 Additional Insured Premium: $0 TRIPRA Premium: $ 2 8 6 Total Policy Premium: $609 Minimum Earned Premium: 25% Minimum Policy Premium: 100% Item 7. AUDIT PERIOD: Not Subject to Audit Basis: Units: 2 U S T s , 8 A S T s Rate: Flat All rates are based on the revenue basis shown above and no deductions 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 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. SURPLUS LINES TAX IS AS FOLLOWS - USING HIGHEST PREMIUM: $6009.00 -PREMIUM W/TRIA $122.68 - WA SLT $ 18.40 - WA STAMPING $125.00 - VALLEY FILING FEE ** DUE DILIGENCE SHOULD BE INCLUDED WITH EMAIL** CRUM&FORSTER FORMS AND ENDORSEMENTS CFSTP 00 001 10 16 COMMERCIAL STORAGE TANK LIABILITY POLICY DECLARATIONS EN002-0211 SCHEDULE OF FORMS AND ENDORSEMENTS IL P 001 01 04 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICY HOLDERS CS 07001 01 21 C&F SPECIALTY SIGNATURE PAGE EN0004-0521 CLAIMS REPORTING EN0005-1017 SERVICE OF PROCESS CLAUSE EN0006 0120 Policyholder Disclosure Notice of Terrorism Insurance Coverage EN0011-1014 PRIVACY NOTICE EN0050-0222 EMERGENCY RESPONSE HOTLINE EN0052-0222 NOTICE OF LOSS ALL CFSTP 00 000 01 15 STORAGE TANK POLLUTION POLICY CFSTP 00 002 0121 DEDUCTIBLE ENDORSEMENT CFSTP 00 501 10 15 MANDATORY NOTICE OF VOLUNTARY REMOVAL OR REPLACEMENT OF UNDERGROUND STORAGE TANKS SYSTEM CFSTP 00 525 05 16 COVERED STORAGE TANK COVERAGE ENDORSEMENT CFSTP 00 546 10 13 LOADING OR UNLOADING COVERAGE ENDORSEMENT CFSTP FR CERT-WA FINANCIAL RESPONSIBILITY CERTIFICATE OF INSURANCE - WA This proposal is based on the insurance carrier's most recent policy forms and endorsements and is subject to all terms and conditions of such forms and endorsements. If you would like to review a copy, please let me know and I would be pleased to send you a specimen form. WARRANTIES/REQUIREMENTS Please be advised that coverage has been proposed conditional upon receipt, review, verification and approval of the following items: Subjectivity Time Frame Signed Terrorism Rejection / Selection Form Prior to Binding Completed Surplus Lines Tax Form WA Annual Leak Testing Checklist within the last 12 months. Prior to Binding Prior To Binding This proposal is valid until the policy 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 Company. 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 which were requested. It is your responsibility to review these terms and conditions prior to presenting this proposal. Crum & Forster Specialty Insurance Company reserves the right to modify, change or cancel any or all terms of this proposal at anytime without notice. CRUM&FORSTER: COVERED STORAGE TANK AND LOCATION ENDORSEMENT Loc Address City State Zip Tank AST Year Capacity Contents Deductible Retroactive # Code # /UST Installed Date 1 124 Enterprise St. SE Ephrata WA 98823 1 UST 1996 9,730 Gasoline $25,000 7/7/2006 1 124 Enterprise St. SE Ephrata WA 98823 2 UST 1996 91730 Diesel $251000 7/7/2006 2 3803 Neva Lake Road Ephrata WA 98823 1 AST 2012 41000 Diesel $500 7/7/2016 2 3803 Neva Lake Road Ephrata WA 98823 2a AST 2012 200 Gasoline $55000 7/7/2016 2 3803 Neva Lake Road Ephrata WA 98823 2b AST 2012 21000 Waste Oil $51000 7/7/2016 3 232 Chelan St. Hartline WA 99135 la AST 1999 8,000 Diesel $5,000 7/7/2016 3 232 Chelan St. Hartline WA 99135 lb AST 1999 400 Gasoline $5,000 7/7/2016 4 24378 Broadway St. Mattawa WA 99344 la AST 1999 200 Gasoline $5,000 7/7/2016 4 24378 Broadway St. Mattawa WA 99344 lb AST 1999 4,000 Diesel $5,000 7/7/2016 5 12171 Wheeler Rd. Moses Lake WA 98837 1 AST 2009 101000 Gasoline $5,000 7/7/2016 5 12171 Wheeler Rd. Moses Lake WA 98837 2 AST 2009 1000 Diesel $5,000 7/7/2016 6 4718 Rd P NW Quincy WA 98848 la AST 2005 8,000 Diesel $51000 7/7/2016 6 4718 Rd P NW Quincy WA 98848 lb AST 2005 4,000 Gasoline $51000 7/7/2016 7 13766 Road E SW Royal CIty WA 99357 la, AST 2003 8,000 Diesel $5,000 7/7/2016 7 13766 Road E SW Royal CIty WA 99357 lb AST 2003 41000 Gasoline $5,000 7/7/2016 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 102(1) 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 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. 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 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 $100 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 $286 I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have no coverage for losses resulting from certified acts of terrorism. Policyholder/Applicant Signature Print Name Date GRANT COUNTY Named Insured/Firm 33 C Street NW, Ephrata, WA, 98823 Mailing Address Quote/Policy Number EN0006 - 0120