Get Public Entities/educational Facilities Pollution Liability Application

Completing the Public Entities/Educational Facilities Pollution Liability Application is essential for obtaining the necessary insurance coverage for pollution liability. This guide will walk you through each section of the application, ensuring you have the needed information to fill it out effectively and accurately.

Follow the steps to complete your application seamlessly.

1. Click ‘Get Form’ button to access the application and open it in the online editor.
2. Begin by filling in the applicant information section. This includes the entity name, office address, state, city, zip code, and the title of the authorized representative.
3. Provide details about the principal environmental contact, including their fax number, telephone number, email address, and the entity's website if applicable.
4. Specify the type of entity by selecting whether it is a governmental subdivision, public entity, educational facility, or other. Enter the number of employees and the service population.
5. In the coverage requested section, indicate the requested coverage, proposed effective date, retroactive date, and the proposed limits and retention.
6. Detail any current or past pollution coverage, including the current carrier, effective dates, limits, retention, and retroactive date.
7. Answer compliance questions regarding past or present pollution conditions, notices of violations, fines, or complaints, and state whether any property locations are in non-compliance.
8. Provide any required supporting documents, including audited financial statements, loss runs, site assessment reports, groundwater monitoring reports, and any applicable storage tank schedules.
9. Complete any necessary addendums pertaining to specific facilities or conditions, ensuring to copy those pages as needed.
10. Finally, review all information for accuracy, sign the application, and date it. You now have the option to save your changes, download, print, or share the completed form.

Start filling out your application online today to ensure your facility is protected.