&EPA
List Of Known
Insurance Providers
For Underground
Storage Tank Owners
And Operators
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CONTENTS
Using This Booklet To Help Meet Financial Responsibility
Requirements 1
How Can You Get The Most Current List? 2
Need More General Information About USTs Or Financial
Responsibility? 2
List Of Insurance Companies 3
List Of Insurance Agents And Brokers 5
Model Of "Endorsement" Criteria 14
Model Of "Certificate Of Insurance" Criteria 15
Please note:
• The following list is not an endorsement by EPA of the products or services
provided by these companies, agents, and brokers.
• You are free to contact anyone you believe can meet your insurance needs.
• The following list is not necessarily comprehensive because it captures only
those who have contacted us as of the date of this publication.
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USING THIS BOOKLET TO HELP MEET FINANCIAL RESPONSIBILITY
REQUIREMENTS
The U.S. Environmental Protection Agency (EPA) developed financial responsibility regulations to
ensure that underground storage tank (LIST) owners and operators can pay the costs of cleaning
up leaks from USTs and compensate third parties for bodily injury or property damage resulting
from leaks.
The financial responsibility regulations (40 CFR Part 280,
Subpart H) allow LIST owners and operators to choose from
a variety of financial mechanisms to comply with the
regulations. One of these financial mechanisms is the use of
insurance.
In order to facilitate access to LIST insurance, EPA
developed this booklet based on information it received from
the listed companies, agents, and brokers. The companies,
agents, and brokers listed may help you - as an LIST owner
or operator - find the LIST insurance that can fulfill your
financial responsibility obligation. See the text box on the
right for a description of the roles of companies, agents, and
brokers.
It is your responsibility to make sure the coverage you
are offered meets federal requirements and any state or
local requirements that may apply to your USTs. If you
choose to use insurance to demonstrate financial
responsibility, you should contact your state insurance
regulatory agency to be sure that your insurer and broker or
agent is authorized to provide that type of insurance. To get
contact information for your state insurance regulatory
agency, call the National Association of Insurance
Commissioners at (816) 842-3600 or visit its website at the
following Internet address:
http://www.naic.org/state_web_map.htm.
Who's Who?
Insurance Company Or
Insurer
A corporation or association
engaged primarily in the
business of furnishing
insurance to the public. The
party to the insurance
contract who promises to pay
losses or benefits.
Insurance Agent
An insurance company
representative who solicits,
negotiates or effects contracts
of insurance, and provides
service to the policyholder for
the insurer.
Insurance Broker
A marketing specialist who
represents buyers of property
and liability insurance and
who deals with either agents
or companies in arranging for
the coverage required by the
customer.
If your insurer adds your LIST coverage to an existing policy,
your insurer should provide you with an endorsement that
conforms to the "Endorsement" criteria described in §280.97
of the financial responsibility rule (40 CFR Part 280, Subpart
H). If your insurer provides you with a new policy, it should conform to the "Certificate Of
Insurance" standard also described in §280.97 of the financial responsibility rule. See pages 14
and 15 of this document for these criteria or you can read the rule at the following Internet
address: http://www.epa.gov/oust/fedlaws/cfr.htm.
Ust Of Known Insurance Providers For UST Owners And Operators
Page 1
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HOW CAN YOU GET THE MOST CURRENT LIST?
The companies, agents, and brokers listed on the following pages have identified themselves as
willing to deal with LIST insurance. The following is not a comprehensive list because there are
doubtless other companies, agents, and brokers who have not yet identified themselves to EPA.
EPA will periodically update this list. The most current version will always be found on the Internet
at: http://www.epa.gov/oust/pubs/inslist.htm.
Printed copies of this list will not be available. It is not practical to update and reprint them as often
as EPA can update the version available on the website.
NEED MORE GENERAL INFORMATION ABOUT USTs OR FINANCIAL
RESPONSIBILITY?
You can go to EPA's website at http://www.epa.gov/oust/pubs to read or download a copy of
Dollars And Sense: Financial Responsibility Requirements For Underground Storage Tanks
(EPA 510-K-95-004), a booklet that briefly and clearly summarizes the financial responsibility
requirements. You can also obtain Dollars And Sense and other publications about underground
storage tank requirements from NSCEP, EPA's publication distributor, by calling 800-490-9198;
writing to NSCEP, Box 42419, Cincinnati, OH 45242; or faxing your order to NSCEP at 301-604-
3408.
Ust Of Known Insurance Providers For UST Owners And Operators Page 2
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LIST OF INSURANCE COMPANIES
Affinity Insurance Services, Inc.
159 E. County Line Road
Hatboro, PA 19040
Phone: (888)253-1461
Fax: (800) 567-4028
Contact: Andrew Memolo
Areas of Coverage: United States, GU, PR, USVI
ACE USA
c/o ACE Environmental Risk
525 West Monroe, Suite 400
Chicago, IL 60661
Phone: (312)775-3929
Fax: (312)775-3958
Contact: David Lau
Internet: www.acetanksafe.com
Area of Coverage: United States
American Safety Insurance Group
100 Galleria Parkway SE, Suite 700
Atlanta, GA 30339
Phone: (800) 388-3647
Fax: (440) 268-7651
Contact: Craig Lass
Internet: www.amsafety.com
Area of Coverage: United States
Berkley Environment, a division of Berkley
Specialty Underwriting Managers LLC.
Three Ravinia Drive, Suite 500
Atlanta, GA 30346
Phone: (404)443-2013
Fax: (888)201-8109
Contact: Heather Rehm-Stelter
Email: tanks@berkleysum.com
Internet: www.berkleysum.com/environmental.htm
Area of Coverage: United States
Chartis
100 Executive Drive, Suite 200
West Orange, NJ 07052
Phone: (973) 669-2347; (800) 336-2007
Fax: (973)731-2288
Contact: Kristin Scott
Internet: www.chartisinsurance.com
Area of Coverage: United States
Colony Specialty
8720 Stony Point Parkway, Suite 300
Richmond, VA 23235
Phone: (800) 577-6614
Fax: (804)327-3175
Internet: www.colonyspecialty.com
Area of Coverage: United States
1451 Larimer Street, Suite 200
Denver, CO 80202
Phone: (303) 534-1171 ext. 109; (800) 377-4152
Fax: (303)623-8101
Contact: Sandy Shannon
Internet: www.feiinsurance.com
Area of Coverage: United States
Garage Service Equipment Dealers Liability
Association of America
8722 South Harrison
Sandy, UT 84070
Phone: (801)304-3788
Fax: (877)452-6910
Contact: Mike Fennell
Internet: www.smallcompanyinsurance.com
Areas of Coverage: United States except CA, CT, NH,
NJ, NY, Rl
Great American Custom
1600 West 7th Street
Fort Worth, TX 76102
Phone: (800)336-1338
Fax: (817)339-3138
Contact: DeeDee Byrne
Internet: www.toptanx.com
Areas of Coverage: CA, Ml, NC, NM, SC, TX, VA, Wl,
WV
Hudson Insurance Group Environmental
100 Wlliam Street, 5th Floor
New York, NY 10038
Phone: (212)978-2812
Contact: David Corby
Internet: www.hudsoninsgroup.com
Area of Coverage: United States
Liberty International Underwriters
55 Water Street
18th Floor
New York, NY 10041
Phone: (212)208-4100
Internet: http://www.liu-usa.com
Area of Coverage: United States
Petroleum Marketers Management Insurance
Company (PMMIC)
Box 7628
Urbandale, IA 50323
Phone: (515)334-3001
Fax: (515)334-3013
Contact: Patrick Rounds
Internet: www.pmmicinsurance.com
Areas of Coverage: AZ, CT, IA, KS, NM, OR, Wl
Freberg Environmental, Inc. Prime Insurance Company
List Of Known Insurance Providers For UST Owners And Operators
Page 3
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8722 South Harrison
P.O. Box 4439
Sandy, UT 84901
Phone: (801)304-5591
Contact: Peter Anderson
Area of Coverage: United States except CA, CT, NH,
NJ, NY, Rl
Prime Insurance Syndicate, Inc.
8722 South, 300 West
Salt Lake City, UT 84070
Phone: (800) 257-5590
Fax: (801)304-5595
Contact: Rick Lindsey
Internet: www.primeis.com
Area of Coverage: United States
Tank Owner Members Insurance Co.
1600 West 7th Street
Fort Worth, TX 76102
Phone: (800)336-1338
Fax: (817)339-3138
Contact: DeeDee Byrne
Internet: www.tankowners.com
Areas of Coverage: NM, TX
U.S. Risk Underwriters, Inc.
10210 North Central Expressway, Suite 500
Dallas, TX 75231
Phone: (800) 232-5830
Fax: (214)265-4958
Contact: Terry Hazelton
Internet: www.usrisk.com
Areas of Coverage: LA, NM, TN, TX
Ust Of Known Insurance Providers For UST Owners And Operators Page 4
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WANT TO ADD AN INSURER, AGENT, OR BROKER TO THE LIST?
NEED TO REMOVE A PROVIDER FROM THE LIST?
EPA will periodically update the list of insurers, agents, and brokers in this booklet. If you are an
insurer, agent, or broker who can provide the insurance described in 40 CFR §280.97, please
contact Cho-Yi Kwan, EPA's Office of Underground Storage Tanks, at 703-347-8908 or
kwan.choyi@epa.gov. You will need to provide your name, address, phone and fax numbers,
Internet address, area of coverage, and the name of a single point of contact within your company.
Please be sure to review the requirements in 40 CFR Part 280, Subpart H, specifically §280.97, to
ensure your company can provide insurance that meets those specific requirements. If your
company is currently listed, but no longer provides this insurance, please contact Cho-Yi Kwan (as
noted above) to have your company removed from the list.
LIST OF INSURANCE AGENTS AND BROKERS
AccusureInsurance Agency
6 East Black Well Street
Dover, NJ 07801
Phone: (973) 366-7850
Fax: (973) 366-7852
Contact: Bob Werner
Internet: www.accusure.com
Area of Coverage: NJ
All Risks, Ltd. (Wholesaler)
1920 Greenspring Drive, Suite 200
Timonium, MD 21093
Phone: (800)366-5810
Fax: (410)828-8179
Contact: Erik Halvorsen
Internet: www.allrisks.com
Area of Coverage: United States
Allied Insurance Managers, Inc.
811 South Blvd East, Suite 110
Rochester Hills, Ml 48307
Phone: (248) 853-0930
Fax: (248)853-1512
Contact: Dennis Cieplak
Internet: www.alliedinsmgr.com
Area of Coverage: Ml
American Heritage Insurance Agency, Inc.
975 Elm Street
West Springfield, MA 01089
Phone: (413)736-1400
Fax: (413)736-0306
Contact: Ray Belden
Internet: www.aainsurance.com
Area of Coverage: MA
Americana Insurance Agency
P.O. Box 428
Danube, MN 56230
Phone: (320) 826-2553
Fax: (320) 826-2630
Contact: Dallas Schneider
Internet: NA
Area of Coverage: MN
American Risk Management Resources
Network, LLC
7507 Hubbard Ave, Suite 200
Middleton, Wl 53562
Phone: (608) 836-9590
Fax: (608) 836-9565
Contact: Angela Oroian
Internet: www.armr.net
Area of Coverage: United States
AmWINS Program Underwriters, Inc.
214 Senate Avenue
Camp Hill, PA 17001-0718
Phone: (717)214-2800
Fax: (717)214-2801
Contact: James Titus
Internet: www.amwins.com/apu
Areas of Coverage: United States, GU, PR
Anderson Insurance Services, Inc.
933 Webster Street
Marshfield, MA 02050
Phone: (800) 878-6578
Fax: (781)837-3756
Contact: Peter Anderson
Internet: www.insuremass.com
Area of Coverage: MA
Ust Of Known Insurance Providers For UST Owners And Operators
PageS
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Arlington/Roe & Co.
8900 Keystone Crossing
P.O. Box 80803
Indianapolis, IN 46280
Phone: (800) 878-9891
Fax: (317)554-8551
Contact: Allen J. Grau; Ruth Kelly
Internet: www.arlingtonroe.com
Areas of Coverage: IL, IN, KY, Ml, OH
Arroyo/Caldwell & Moreland Insurance Services
P.O. Box 6185
San Bernadino, CA 92412
Phone: (909) 889-0295
Fax: (909) 888-3422
Contact: John Terry
Internet: NA
Areas of Coverage: CA and limited coverage in some
states
Associated Insurance Agencies, Inc.
63 Commerce Park Drive
Westerville, OH 43082
Phone: (614)882-2335
Fax: (614)882-2340
Contact: Tim Bowers
Internet: www.associated-ins.com
Area of Coverage: OH
Axia Insurance Group
209 West Central Street, Suite 102
Natick, MA 01760
Phone: (508)651-2100
Fax: (508)651-2101
Contact: Michael Hackett
E-mail: mhackett@axiagroup.net
Internet: www.axiagroup.net
Areas of Coverage: CT, MA, NE, NH, Rl, VT
Bain Insurance Agency
P.O. Box 659
Bandon, OR 97411
Phone: (541)347-3435
Fax: (541)347-9232
Contact: Joseph Bain
Internet: www.baininsurance.com
Area of Coverage: TX
Bayrisk Insurance Brokers, Inc
P.O. Box 567
Alameda, CA 94501
Phone: (510)523-3435
Fax: (510)523-7449
Contact: Kevin Milroy
Internet: www.bayrisk.com
Areas of Coverage: CA, NV, OR
Beacon Hill Associates
P.O. Box1532
Charlottesville, VA 22902
Phone: (800)596-2156
Fax: (434) 979-8964
Contact: William Pritchard
Internet: www.b-h-a.com
Area of Coverage: United States
Berger Briggs Real Estate & Insurance, Inc.
215 3rd Street, SW
P.O. Drawer K
Albuquerque, NM 87103
Phone: (505) 247-0444
Fax: (505)243-1505
Contact: Berger Briggs
Internet: www.bergerbriggs.com
Area of Coverage: Southwest United States
Bill Taylor & Associates
P.O. Drawer 2229
San Marcos, TX 78667-2229
Phone: (800) 606-6221
Fax: (512)392-5443
Contact: Bill Taylor
Internet: www.btainsurance.com
Area of Coverage: TX
Brady & Company
P.O. Box107502
Anchorage, AK 99510
Phone: (907) 276-5627
Fax: (907) 276-6292
Contact: Judy Chadwick
Internet: www.bradycompany.com
Area of Coverage: United States
Braley & Wellington Insurance Agency Corp.
P.O. Box15127
Worcester, MA 01615-0127
Phone: (508) 754-7255
Fax: (508) 797-3507
Contact: Parker Wellington, Jr.
Internet: www.braleywellingtongroup.com
Areas of Coverage: CT, MA, NH, Rl, VT
Brian Spears Agency, Inc.
684 A Fairview Road
P.O. 6ox 80280
Simpsonville, SC 29680
Phone: (864) 228-0754
Fax: (864) 228-0853
Contact: 6rian Spears
Internet: spearsb@nationwide.com
Area of Coverage: SC
Brier Insurance Agency
30 Maple Drive
Wexford, PA 15090
Phone: (724) 935-5924
Fax: (724)935-1730
Contact: Dana 6rier
Internet: www.brieragency.com
Area of Coverage: PA
Brown Agency
110 S. Willow St., Suite 106
Kenai, AK 99611
Phone: (907) 283-7834
Fax: (907)283-6179
Contact: Doug 6rown
Internet: www.brownak.net
Area of Coverage: AK
Ust Of Known Insurance Providers For UST Owners And Operators
Page 6
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Brown & Brown Public Entity Services
One International Centre
100 N.E. Loop 410, Suite 965
San Antonio, TX 78216
Phone: (210)340-8985
Fax: (210)340-8986
Contact: Robert Hughes
Internet: www.bbpes.com
Area of Coverage: United States
Burns & Wilcox Ltd.
2301 E. Lamar Boulevard
Arlington, TX 76006
Phone: (800)442-1496
Fax: (817)652-9090
Contact: Sheila Hailey
Internet: www.burnsandwilcox.com
Area of Coverage: TX
Cambridge General Agency
100 Pine Street, Suite 250
San Francisco, CA 94111
Phone: (415) 955-8555 ext. 57
Fax: (415)394-6305
Contact: Julie Sylim-Uang
Internet: www.cambridgega.com
Area of Coverage: CA
Capacity Group of NY, LLC
900 Merchants Concourse, Suite 414
Westbury, NY 11590
Phone: (516)280-7676
Fax: (516)280-7677
Contact: Vincent Franco
Internet: NA
Area of Coverage: United States
Central Insurance Agency, Inc.
6000 North Lamar Boulevard, Suite 100
Austin, TX 78761
Phone: (512)451-6551
Fax: (512)454-0183
Contact: Scott Raper
Internet: www.centralins.com
Area of Coverage: TX
Centralia General Agencies, Inc.
P.O. Box 698
2091/2W. Main Street
Centralia, WA 98531
Phone: (360) 736-8281; (800) 700-8281
Fax: (360) 736-4740
Contact: Terry Mosier or Janine Hislop
Internet: www.centraliageneralins.com
Area of Coverage: WA
Chamber Insurance Agency Services LLC
1700 Market Street, Suite 2000
Philadelphia, PA 19103
Phone: (215)255-6471
Fax: (877)-594-6502
Contact: Susan DiDomenico
Internet: www.chamberagent.com
Area of Coverage: United States (except FL)
Chamberlin Insurance
764 Campbell Avenue
West Haven, CT 06516
Phone: (203) 932-5877
Fax: (203) 932-9328
Contact: Roger Chamberlin
Internet: www.chamberlininsurance.com
Area of Coverage: CT
Commonwealth Underwriters, Ltd.
P.O. Box 5441
Richmond, VA 23220
Phone: (804) 359-4568
Fax: (804) 359-6994
Contact: Ben Kusterer
Internet: www.commund.com
Areas of Coverage: MD, NC, PA, VA
Connelly-Campion-Wright
704 Belmar Plaza
Belmar, NJ 07719
Phone: (800) 924-2809
Fax: (732)681-4951
Contact: Tara Maolini
Internet: www.ccwinsurance.com
Area of Coverage: NJ
Continental Agency of CT, Inc.
P.O. Box187109
Hamden, CT 06518-0109
Phone: (800) 922-2563
Fax: (203)288-2312
Contact: Brendan Mullally
Internet: www.ca-group.com
Areas of Coverage: CT, MA, ME, NH, Rl, VT
Continental/Marmorstein & Malone Insurance
305 Route 17 South
Paramus, NJ 07652
Phone: (800) 932-0849
Fax: (201)261-8922
Contact: Michael Kane
Internet: www.ca-group.com
Areas of Coverage: CT, NJ, NY
Cooney, Rikard & Curtin, Inc. (CRCINS)
P.O. Box 59689
Birmingham, AL 35259-9689
Phone: (205) 870-7790; (800) 824-1709
Fax: (205) 879-3739
Contact: Charles Wood
Internet: www.crcins.com
Area of Coverage: United States
Crawley Warren Insurance Services, Inc.
100 California, Suite 650
San Francisco, CA 94111
Phone: (415) 544-0969 ext. 304
Fax: (415)544-0974
Contact: Cass Alimonti
Internet: www.crawleywarrenins.com
Areas of Coverage: CA, HI
Ust Of Known Insurance Providers For UST Owners And Operators
Page 7
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Crump Insurance Services NW
21540 30th Drive SE, Suite 100
Bothell, WA 98021
Phone: (800) 221-9628
Fax: (425)398-1133
Contact: Leslie Myer or Terry Brown
Internet: www.crumpins.com
Areas of Coverage: OR, WA
Custom Environmental Insurance
P.O. Box 29664
Richmond, VA 23242
Phone: (804) 876-4120, (877) 826-5268
Fax: (804)876-4119
Contact: Kara Koedel
Internet: www.tankcov.com
Area of Coverage: United States
Dana Insurance and Risk Management
9-B W. Ridgely Road, Suite 100
Timonium, MD 21093
Phone: (800)821-1990
Fax: (410)821-1997
Contact: Eric Dana
Internet: www.dana-ins.com
Area of Coverage: United States
Dean Insurance Agency, Inc.
P.O. Box 669
Bel Air, MD 21014-0669
Phone: (410)838-3700
Fax: (410)893-3647
Contact: Norman Dean
Internet: www.deaninsurance.com
Area of Coverage: MA
Delaware Valley Underwriting Agency, Inc.
420 S. York Road
Hatboro, PA 19040
Phone: (215) 443-3500; (800) 388-0215
Fax: (215)672-7983
Contact: Rita Hanebury
Internet: www.dvua.com
Areas of Coverage: DE, MD, NJ, NY, OH, PA, VA, WV
Dennis Insurance Agency
822 Market Street, Suite 3
Zanesville, OH 43701
Phone: (800)450-7117
Fax: (740) 450-0203
Contact: Jeff Dennis
Internet: www.dennisinsuranceagency.com
Area of Coverage: OH
Diversified Insurance Services
100 N. Corporate Dr. Suite 100
Brookfield, Wl 53045
Phone: (262) 439-4700
Fax: (262) 439-4899
Toll free 800-313-0172
Contact: Kathy Mikula Wistrom
Internet: www.div-ins.com
Area of Coverage: United States
Don-Rick Insurance
313 Oak Street
Baraboo, Wl 53913
Phone: (800) 924-6536 ext. 129
Fax: (608) 356-9022
Contact: Ed Kothbauer
Internet: www.don-rick.com
Area of Coverage: Wl
Elliott, Powell, Baden & Baker Inc.
1521 SW Salmon Street
Portland, OR 97205
Phone: (503)227-1771
Fax: (503) 274-7644
Contact: Pam Wimmer
Internet: www.epbb.com
Area of Coverage: OR, WA, ID, MT, UT, AZ, AK
Environmental Insurance Agency
P.O. Box 23605
Portland, OR 97281
Phone: (503) 977-3333
Fax: (503) 977-3334
Contact: Jenn Hickey
Internet: www.eiains.com
Area of Coverage: United States
Environmental Insurance Agency, Inc.
138 Chatsworth Avenue, Suite 2
Larchmont, NY 10538
Phone: (914)833-5100
Fax: (914)833-5102
Contact: Susan Neuman
Internet: www.enviroinsurance.com
Area of Coverage: United States
First American Insurance Agency, Inc.
625 Front Street
Chicopee, MA 01013
Phone: (413)592-0995
Contact: Remmy Nartens
Internet: www.faiagency.com
Area of Coverage: United States
Forsyth Insurance Group, Inc.
201 S. Fourth
Springfield, IL 62705
Phone: (217)525-9500
Fax: (217)528-1526
Contact: Bob Ford
Internet: NA
Areas of Coverage: IL, IN, Ml, MN, OH
Four Star Insurance Agency, Inc.
5835 Pearl Road
Parma, OH 44130
Phone: (440) 888-4525
Fax: (440) 888-0320
Contact: Joe Germana
Internet: www.fourstarinsurance.com
Area of Coverage: OH
Ust Of Known Insurance Providers For UST Owners And Operators
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Fox and Fox Insurance Agency, Inc.
101 East 38th Street
Indianapolis, IN 46205
Phone: (317)925-1456
Fax: (317)927-5178
Contact: Jim Fox
Internet: NA
Area of Coverage: United States
Gallen Insurance
2237 Lancaster Pike
Shillington, PA 19607
Phone: (610)777-4123
Fax: (610)777-9957
Contact: Allen Convey
Internet: NA
Area of Coverage: PA
Garrett Insurance Company
P.O. Box 291425
Kerrville, TX 78029-1425
Phone: (830) 896-6600
Fax: (839)896-1822
Contact: Bob Shmerbeck
Internet: www.garrettinsurance.com
Area of Coverage: TX
GBP Risk Solutions
P.O. Box13598
Tucson, AZ 85732-3598
Phone: (520) 571-7737; (800) 933-9646
Fax: (520)571-9115
Contact: Rick Gregson
Internet: www.gbprs.com
Area of Coverage: AZ
Green Insurance Services
1500 Sixth Street, NW
Winter Haven, FL 33881
Phone: (800)476-1106
Fax: (863) 294-4243
Contact: Jim Green
Internet: www.greeninsurance.com
Area of Coverage: FL
Griffin Underwriting Services
1980112th Avenue NE, Suite 210
Bellevue, WA 98004
Phone: (800) 562-8095
Fax: (425) 453-8696
Contact: Lillian Nixon
Internet: gogus.com
Areas of Coverage: OR, WA
GST Group, Inc.
2291 Bristol Pike
Bensalem, PA 19020
Phone: (800) 220-2088
Fax: (215)245-0422
Contact: Mike Smith
Internet: www.gstgroup.com
Areas of Coverage: DC, DE, MD, NJ, NY, PA, VA
Harrison, Fincher & Associates
2712 Middleburg Drive, Suite 203
Columbia, SC 29204
Phone: (803) 254-0330
Contact: Becky Fincher
Internet: NA
Areas of Coverage: GA, NC, SC
Hays Companies of Texas
10333 Richmond Avenue, Suite 720
Houston, TX 77042
Phone: (832) 209-4900
Fax: (832) 209-4865
Contact: John Watkins
Email: Jwatkins@hayscompanies.com
Internet: www.hayscompanies.com
Area of Coverage: United States
Highland Insurance, Inc.
P.O. Box 2487
Huntington, WV 25725-2487
Phone: (304) 529-3381
Fax: (304) 529-6623
Contact: Robert Cline
Internet: NA
Areas of Coverage: KY, OH, VA, WV
Hill & Kehne, LLC
2300 Wisconsin Avenue NW, Suite 300
Washington, DC 20007
Phone: (202)558-2100
Fax; (202)558-2127
Contact: Tiffany Germain
Internet: www.hillkehne.com
Area of Coverage: United States
Hillcrest Agency, LLC
30 Main Street
Centerbrook, CT 06409
Phone: (860)767-9190
Fax; (860)767-9196
Contact: Diane M. Vizzo
Internet: www.hillcrestagency.com
Area of Coverage: CT, MA, NH, NY, Rl
Hometown Insurance of Smithtown
1461 Lakeland Avenue, Suite 3
Bohemia, NY 11716
Phone: (631)589-0100
Fax: (516)589-0164
Contact: Eric Keiffert
Internet: NA
Area of Coverage: NY
Hudson & Muma, Inc
4600 Coolidge Highway, Suite 100
Royal Oak, Ml 48073
Phone: (248)549-3519
Fax: (248) 549-6452
Contact: Jim Thurman
Internet: www.hudsonmuma.com
Area of Coverage: United States
Ust Of Known Insurance Providers For UST Owners And Operators
Page 9
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Hutcherson Insurance Agency
P. O. Box 430
Gainesville, TX 76241
Phone: (940)665-4711
Fax: (940) 665-7363
Contact: Shelia Colwell
Internet: hutchersoninsurance.com
Areas of Coverage: OK, TX
Independent Insurance Wholesalers, Inc.
808 Southwest 3rd Avenue
Portland, OR 97204
Phone: (503) 224-1956; (800) 886-9235
Fax: (503)224-3010
Contact: Tom Sawyer
Internet: www.iiw.com
Areas of Coverage: AK, CA, ID, OR, WA
Insurance Market: A Yaworsky Company
3453 Pelham Road
Greenville, SC 29615
Phone: (864) 438-0557, (877) 679-0008
Fax: (864)751-6333
Contact: Nick Yaworsky
Internet: www.theinsurancemarketonline.com
Areas of Coverage: CT, FL, GA, NC, PA, SC, TX
Intercorp, Inc.
138-F Main Street
Ephrata, PA 17522
Phone: (717)721-3500
Fax: (717)721-3515
Contact: Mark Waltman
Internet: www.intercorpinc.net
Area of Coverage: United States
ISU BC Environmental Insurance Brokers, Inc.
1037 Suncast Lane, Suite 103
El Dorado Hills, CA 95762
Phone: (916) 939-1080, (800) 257-1639
Fax: (916)939-1085
Contact: Kevin Woodwick / Marci Teschner
Internet: www.environmentalinsurance.com
Area of Coverage: United States
John Hackney Agency, Inc.
P.O. Box 998
3700 Nash Street North
Wilson, North Carolina 27894
Phone: (252) 291-3111 ext. 209
Fax: (252)291-6306
Direct Phone: (252) 265-8070
Contact: Mark A. Resell
Internet: mark@johnhackneyagency.com
Areas of Coverage: GA, NC, SC, TN, VA
Kennedy Professional Insurance Agency
P.O. Box 847
Apple Valley, CA 92307
Phone: (760) 242-2345
Fax: (760)242-2211
Contact: Kevin Kennedy
Internet: www.kpia.com
Area of Coverage: CA
Klinger Associates, Inc.
P.O. Box 503526
Indianapolis, IN 46256
Phone: (317)542-9890
Fax: (317)542-0685
Contact: Bob Klinger
Internet: NA
Area of Coverage: IN
Laginess Insurance Agency, Inc.
199 North Main Street, Suite B7
Plymouth, Ml 48170
Phone: (734) 455-5088
Fax: (734) 455-2750
Contact: Terry Laginess
Internet: www.laginess.com
Area of Coverage: Ml
Lisuzzo Insurance Agency, Inc.
1535 Central Avenue
Albany, NY 12205
Phone: (518)869-4466
Fax: (518)869-4296
Contact: Steve Lisuzzo
Internet: www.lisuzzo.com
Areas of Coverage: FL, NY, PA
Lockton Companies, LLC
444 West 47th Street, Suite 900
Kansas City, MO 64112
Phone: (816)960-9465
Fax: (816)783-9465
Contact: Matthew J. Pateidl
Internet: www.lockton.com
Area of Coverage: United States
M3 Insurance Solutions, Inc.
3113W. Beltline Highway
B.O. Box 8950
Madison, Wl 53708-8950
Phone: (608) 228-2703
Fax: (608)273-1725
Contact: Heidi M. Lobraco
Internet: www.m3ins.com
Area of Coverage: United States
M.J. Kelly
P.O. Box 231
Turners, MO 65765
Phone: (800)725-7211
Fax: (417)883-7103
Contact: Lori Drake
Internet: www.mjkelly.com
Areas of Coverage: AR, FL, IA, IL, KS, MO, OK
Marsh
P.O. Box2151
Spokane, WA 99210-2151
Phone: (800) 525-7012
Fax: (509) 358-3937
Contact: Michele Williams
Internet: www.marsh.com
Area of Coverage: WA
Ust Of Known Insurance Providers For UST Owners And Operators
Page 10
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McElveen Insurance Agency, Inc.
Division of Arthur J. Gallagher and Co.
700 West Prien Lake Road
Lake Charles, LA 70601
Phone: (337) 478-5485
Fax: (337) 478-8660
Contact: Louis Todd
Internet: www.ajg.com
Area of Coverage: United States
McNamara Company
1330 Highway 96 East
St. Paul, MN 55110
Phone: (651)426-0607
Fax: (651)426-2031
Contact: Kathleen McNamara
Internet: www.mcnamaracompany.com
Area of Coverage: United States
Midwest General Agency
3300 Birch Street
Eau Claire, Wl 54702
Phone: (715)832-4000
Fax: (715)834-7117
Contact: Tim Proue
Internet: www.mgarws.com
Areas of Coverage: MN, Wl
Morgan-Marrow Environmental Insurance
484 Viking Drive, Suite 140
Virginia Beach, VA 23452
Phone: (757) 865-1900; (800) 683-8493
Fax: (757)431-8256
Contact: Jason P. Magruder
Internet: www.morganmarrow.com
Area of Coverage: United States
Morrell, Butz, & Junker, Inc.
100 Park Manor Drive
Pittsburgh, PA 15205
Phone: (412) 571-1010; (888) 222-8891
Fax: (412)446-1022
Contact: Bill Kaiser
Internet: www.mbjinsurance.com
Area of Coverage: United States
National Environmental Coverage Corporation
747 Chestnut Ridge Road, Suite 305
Chestnut Ridge, NY 10977
Phone: (845) 425-2333; (800) 552-0230
Fax: (845) 425-2853
Contact: Todd Turner
Internet: www.necc.com
Area of Coverage: United States
National Program Management, Inc.
3457 Lawrenceville Suwanee Road, Suite C
Suwanee, GA 30024
Phone: (678) 730-0505 ext 226
Fax: (678)730-0509
Contact: Bruce Kersey
Internet: www.npminc.com
Area of Coverage: United States
New Office Business Systems of America, Inc
375 Commerce Parkway
Rockledge, FL 32955
Phone: (321)433-4046
Fax: (321)433-1093
Contact: Ben Harrison
Internet: www.policymanagers.com
Area of Coverage: FL
North Island Facilities, Ltd. (NIF) Services
30 Park Avenue
Manhasset, NY 11030
Phone: (516) 365-7440; (800) 892-8892
Fax: (516)365-7392
Contact: Daphney Alvarado
Internet: www.nifgroup.com
Area of Coverage: United States
Northeastern Underwriters, Ltd.
P.O. Box 1310
Madison, CT 06443
Phone: (203)245-7169
Fax: (203)245-0018
Contact: James Davidson or Barbara Bunting
Internet: www.marine-ins.com
Area of Coverage: CT, MA, NY, Rl
NSM, Inc.
Tanklnsure Storage Tank Liability Program
1000 River Road, Suite 200
Conshohochen, PA 19428
Phone: (610)941-9877
Fax: (610)941-9889
Contact: Thomas Zapalac
Internet: www.tankinsure.com
Area of Coverage: United States
O'Dell Insurance Agency
136 South Stygler Road
Gahanna, Ohio 43230
Phone: (614) 475-4786; (800) 743-8467
Fax: (614)475-7154
Contact: Margot O'Dell or Debbie Blue
Internet: www.odell-insurance.com
Area of Coverage: OH
Ogren Insurance
6929 Hohmen Avenue
Hammond, IN 46324
Phone: (219)933-0076
Fax: (219)933-0080
Contact: Thomas Ogren
Internet: www.ogreninsurance.com
Areas of Coverage: AL, AZ, CO, FL, ID, IL, IN, Ml, OH,
PA, TX, VA, Wl
People's United Insurance Agency, Inc.
One Goodwin Square
Hartford, CT06103
Phone: (860) 524-7658
Fax: (860) 722-7760
Contact: J. Michael Collier
Internet: www.peoples.com/insurance
Area of Coverage: United States
Ust Of Known Insurance Providers For UST Owners And Operators
Page 11
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Petra Insurance Agency
P.O. Box 936
Chehalis, WA 98532
Phone: (360) 748-8855; (800) 346-2519
Fax: (360) 748-7260
Contact: Kevin Thompson
Internet: www.localaccess.com/jmpetra
Area of Coverage: WA
Pollution and Property Insurance Specialists LLC
6 Lakeview Court
North Brunswick, NJ 08902
Phone: (732) 348-8571
Fax: (732) 348-8572
Contact: Aldo Salonna
Email: asalonna@ppisinsurance.net
Areas of Coverage: DE, NJ, NY, PA
Professional Liability Brokers and Consultants
175 E. Hawthorn Parkway, Suite 310
Vernon Hills, IL 60061
Phone: (847)816-4480
Fax: (847)816-4484
Contact: Erv Kranberg
Internet: www.plbc.com
Area of Coverage: United States
Public Risk Underwriters
(Division of Brown & Brown Insurance)
615 Crescent Executive Court, Suite 600
Lake Mary, FL 32746
Phone: (321)832-1450
Fax: (321)832-1489
Contact: Pat Adams
Internet: www.publickrisk.com
Area of Coverage: United States
Quaker Special Risk
P.O. Box 415
Sea Girt, NJ 08750
Phone: (732) 223-6666; (800) 447-4180
Fax: (732) 223-9072
Contact: Mike Walsh
Internet: www.qsr-insurance.com
Area of Coverage: United States
Rebsamen Insurance
P.O. Box50810
Springfield, MO 65805
Phone: (417)866-7222
Fax: (417)866-0712
Contact: John West
Internet: www.rebsamen.com
Area of Coverage: United States
ReleaseGuard
615 N Capital Avenue
Lansing, Ml 48933
Phone: (866) 423-4878
Fax: (517)371-7121
Contact: Allen Chadderdon
Internet: www.releaseguard.com
Area of Coverage: United States
Rig Morgan Insurance
P.O. Box 202438
Austin, TX 78720
Phone: (800)291-1061
Fax: (512)219-5601
Contact: Georgette Hardy
E-mail: ghardy45@yahoo.com
Internet: NA
Area of Coverage: TX
RISC
2001 Bryan Street, Suite 2900
Dallas, TX 75201
Phone: (214) 954-0707 ext.101; (800) 725-7472
Fax: (214)954-0999
Contact: Jere Freel
Internet: www.gorisc.com
Area of Coverage: United States
Sigel Insurance Group
P.O. Box 488
Schwenksville, PA 19473
Phone: (610) 287-8800; (800) 243-5041
Fax: (610)287-5348
Contact: Eric Sigel
Internet: www.sigelinsurance.com
Areas of Coverage: DE, MD, NJ, PA
SilverStone Group
11516 Miracle Hills Drive, Suite 100
Omaha, NE 68154
Phone: (402) 964-5516; (800) 288-5501
Fax: (402)557-6335
Contact: Andrew Fereday
Area of Coverage: Midwest United States
Specialty Risk Associates, Inc.
2800 Youree Drive, Suite 462
Shreveport, LA 71104
Phone: (318)865-7023
Fax: (318)865-7049
Contact: John Wood
Internet: www.specialty-risk.com
Area of Coverage: LA
Starfire Insurance
2375 NE 25th Avenue, Suite C
Ocala, FL 34470-3901
Phone: (352)789-6683
Fax: (352)789-6683
Contact: Mark Sears
Email: mark@sffsllc.com
Area of Coverage: FL
Tanksurance
110 East King Street
Lancaster, PA 17602
Phone and Fax: (888) 910-8265
Contact: Tim Donnellon
Internet: www.tanksurance.com
Areas of Coverage: MD, NJ, NY, OH, PA
Ust Of Known Insurance Providers For UST Owners And Operators
Page 12
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Tejas American General Agency, LLC (TAGA)
P.O. Box 3009
Cedar Park, TX 78630
Phone: (512) 346-0030; (888) 999-8242
Fax: (512)342-2803
Contact: Anita Herzog
Internet: www.taga1.com
Area of Coverage: TX
The Abe Peinado Insurance Group
801 Myrtle Ave, Suite 105
El Paso, TX 79901
Phone: (915)351-0973
Fax: (915)351-0975
Contact: Abe Peinado
Internet: www.elpasobusinessinsuranceagent.com
Areas of Coverage: United States, except AK and HI
The DJB Group
231 Chestnut Street
Meadville, PA 16335
Phone: (814)724-1516
Fax: (814)337-2793
Contact: Daniel J. Severe
Internet: www.djbgroup.com
Areas of Coverage: OH, PA, WV
The McCall Insurance Agency, Inc.
609 West 15th Street, Suite 200
Piano, TX 75075
Phone: (972) 423-3595; (800) 423-3595
Fax: (972) 578-9268
Contact: Suzanne Van Meter
Internet: www.mccallagency.com
Area of Coverage: TX
The Spofford Group Insurance Brokerage LTD
14 Main Street
Hingham, MA 02043
Phone: (781)740-8990
Fax: (781)7408770
Contact: Mark L. Liffers
Internet: www.spoffordgroup.com
Area of Coverage: United States
Tower Special Facilities, Inc.
N14 W23777 Stone Ridge Drive, Suite 140
Waukesha, Wl 53188
Phone: (262) 513-6000 ext. 24; (800) 837-1525
Fax: (262)513-6010
Contact: Gary Kubesch
Internet: www.towerspecial.com
Area of Coverage: United States
True Benchmark Insurance Services
1100 Jorie Boulevard, Suite 126
Oak Brook, IL 60523
Phone: (630) 645-0500
Fax: (630) 645-0501
Contact: Michael White
Internet: NA
Area of Coverage: United States
UCPM, Inc.
1955 S. Val Vista Dr., Suite 201
Mesa, AZ 85204-7307
Phone: (800)685-8185
Fax: (480)777-8917
Contact: Ryan Noble
Internet: www.ucpm.com
Area of Coverage: United States
United Assurance, Inc.
16-00 Pollitt Drive
Fair Lawn, NJ 07410
Phone: (800)866-0161
Fax: (201)797-4455
Contact: Thomas Perna
Internet: www.unitedassurance.com
Area of Coverage: Northeast United States
USAssure Insurance Services, Inc.
P.O. Box10670
Jacksonville, FL 32247-0670
Phone: (800)713-1158
Fax: (888) 828-9427
Contact: Erin Corbitt
Internet: USAssure.com
Area of Coverage: United States
USI Southwest
1445 Ross Avenue, Suite 4200
Dallas, TX 75202
Phone: (214)443-3103
Fax: (214)443-3900
Contact: Shawn Heiser (shawn.heiser@usi.biz)
Internet: www.usi.biz
Area of Coverage: United States
USTI (Underground Storage Tank Insurance of
Ohio)
210 Bell Street
Chagrin Falls, OH 44022
Phone: (440)247-3750
Fax: (440)247-3720
Contact: Robert T. Barbero, CPCU
Area of Coverage: OH
Village Insurance Agency, Inc.
P.O. Box 579
Grove City, Ohio 43123
Phone: (614)875-3010
Toll Free: (888) 875-3010
Fax: (614)875-3030
Contact: Don Mulchaey
Internet: www.viaoh.com
Area of Coverage: OH
Wade S. Dunbar Insurance Agency
800 Atkinson Street
Laurinburg, NC 28352
Phone: (910)610-2352
Fax: (910)277-3590
Contact: Cynthia Foland
Internet: cynthia@wsdunbar.com
Area of Coverage: NC
Ust Of Known Insurance Providers For UST Owners And Operators
Page 13
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Wang Insurance Agency, Inc.
2620 Judah Street
San Francisco, CA 94122
Phone: (415)731-7062
Fax: (415)731-8168
Contact: Paul Wang
Internet: www.wangins.com
Area of Coverage: CA
Watson Agency
P.O. Box 249
Chesnee, SC 29323
Phone: (800) 869-2204
Fax: (864)461-3980
Contact: Randy Roberts
Internet: www.watsonagency.net
Area of Coverage: SC
Westex Insurance Agency
15701 Henderson Pass
San Antonio, TX 78232
Phone: (201) 494-9105, (800) 299-2211
Fax: ((210)494-0079
Contact: John F. Thabet
Internet: www.westexia.com
Area of Coverage: TX
WISA, Inc.
P.O. Box 7568
Ewing, NJ 08628
Phone: (609)883-4190
Fax: (609) 538-0274
Contact: Neil Wesley
Internet: www.wesleyinsurance.com
Area of Coverage: United States
Willis HRH
Three Copley Place, Suite 300
Boston, MA 02116
Phone: (617)351-7530
Cell phone: (781)500-9244
Contact: Michael Balmer
Internet: www.willis.com/Client_Solutions/Services/
Environmental/
Area of Coverage: United States
Worldwide Facilities, Inc.
3530 Wilshire Boulevard, Suite 1500
Los Angeles, CA 90010
Phone: (213)380-4670
Fax: (213)384-5180
Contact: Davis Moore
Internet: NA
Area of Coverage: United States
Zain Jeewanjee Insurance Agency
6155 Almaden Expressway
San Jose, CA 95120
Phone: (408) 997-7718; (800) 257-7718
Fax: (408) 997-7890
Contact: Zain Jeewanjee
Internet: www.jeewanjee.com
Areas of Coverage: AZ, CA, FL, GA, IL, NJ, NY, TX,
VA
Zutz Insurance / Professional Liability Insurance
P.O. Box 2287
Wlmington, DE 19899
Phone: (302) 658-8000; (800) 441-9385
Fax: (302)658-8015
Contact: Matthew Doyl
Internet: www.zutzgroup.com
Area of Coverage: United States
Ust Of Known Insurance Providers For UST Owners And Operators
Page 14
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Model Of "Endorsement" Criteria
Name: [name of each covered location]
Address: [address of each covered location]
Policy Number:
Period of Coverage: [current policy period]
Name of [Insurer or Risk Retention Group]
Address of [Insurer or Risk Retention group]
Name of Insured:
Address of Insured:
1. This endorsement certifies that the policy to which
the endorsement is attached provides liability insurance
covering the following underground storage tank(s):
[List the number of tanks at each facility and the
name(s) and address(es) of the facility(ies) where the
tanks are located. If more than one instrument is used
to assure different tanks at any one facility, for each
tank covered by this instrument, list the tank
identification number provided in the notification
submitted pursuant to 40 CFR §280.22, or the
corresponding state requirement, and the name and
address of the facility.]
for [insert: "taking corrective action" and/or
"compensating third parties for bodily injury and
property damage caused by" either "sudden accidental
releases" or "nonsudden accidental releases" or
"accidental release"; in accordance with and subject to
the limits of liability, exclusions, conditions, and other
terms of the policy; if coverage is different for different
tanks or locations, indicate the type of coverage
applicable to each tank or location] arising from
operating the underground storage tank[s] identified
above.
The limits of liability are [insert dollar amount of the "per
occurrence" and "annual aggregate" limits of the
Insurer's or Group's liability; if the amount of coverable
on for different underground storage tanks or locations,
indicate the amount of coverage for each type of
coverage and/or for each underground storage tank or
location], exclusive of legal defense costs, which are
subject to a separate limit under the policy. This
coverage is provided under [policy number]. The
effective date of said policy is [date].
2. The insurance afforded with respect to such
occurrences is subject to all of the terms and conditions
of the policy; provided, however, that any provisions
inconsistent with subsections (a) through (e) of this
Paragraph 2 are hereby amended to conform with
subsections (a) through (e):
a. Bankruptcy or insolvency of the insured shall not
relieve the ["Insurer" or "Group"] of its obligations under
the policy to which this endorsement is attached.
b. The ["Insurer" or "Group"] is liable for the payment of
amounts within any deductible applicable to the policy
to the provider of corrective action or a damaged third
party, with a right of reimbursement by the insured for
any such payment made by the ["Insurer" or "Group"].
This provision does not apply with respect to that
amount of any deductible for which coverage is
demonstrated under another mechanism or
combination of mechanisms as specified in 40 CFR
§280.95-§280.102.
c. Whenever requested by [a Director of an
Implementing Agency], the ["Insurer" or "Group"]
agrees to furnish to [the Director] a signed duplicate
original of the policy and all endorsements.
d. Cancellation or any termination of the insurance by
the ["Insurer" or "Group"], except for non-payment of
premium or misrepresentation by the insured, will be
effective only upon written notice and only after the
expiration of 60 days after a copy of such written notice
is received by the insured. Cancellation for non-
payment of premium or misrepresentation by the
insured will be effective only upon written notice and
only after expiration of a minimum of 10 days after a
copy of such written notice is received by the insured.
[Insert for claims-made policies:
e. The insurance covers claims otherwise covered by
the policy that are reported to the ["Insurer" or "Group"]
within six months of the effective date of the
cancellation on non-renewal of the policy except where
the new or renewed policy has the same retroactive
date or a retroactive date earlier than that of the prior
policy. And which arise out of any covered occurrence
that commenced after the policy retroactive date, if
applicable, and prior to such policy renewal or
termination date. Claims reported during such
extended reporting period are subject to the terms,
conditions, limits, including limits of liability, and
exclusions of the policy.]
I hereby certify that the wording of this instrument is
identical to the wording in 40 CFR §280.97(b)(1) and
that the ["Insurer" or "Group"] is ["licensed to transact
the business of insurance or eligible to provide
insurance as an excess or surplus lines insurer on one
or more states."]
[Signature of authorized representative or Insurer or
Risk Retention Group]
[Printed name of person signing]
[Title of person signing], Authorized Representative of
[name of Insurer of Risk Retention group]
[Address of Representative]
Ust Of Known Insurance Providers For UST Owners And Operators
Page 15
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Model Of "Certificate Of Insurance" Criteria
Name: [name of each covered location]
Address: [address of each covered location]
Policy Number:
Period of Coverage [current policy period]:
Name of [Insurer or Risk Retention Group]:
Address of [Insurer or Risk Retention Group]:
Name of Insured:
Address of Insured:
1. [Name of Insurer or Risk Retention group], [the
"Insurer" or "Group"], as identified above, hereby
certifies that it has issued liability insurance covering
the following underground storage tank(s):
[List the number of tanks at each facility and the
name(s) and address(es) of the facility(ies) where the
tanks are located. If more than one instrument is used
to assure different tanks at any one facility, for each
tank covered by this instrument, list the tank
identification number provided in the notification
submitted pursuant to 40 CFR §280.22, or the
corresponding state requirement, and the name and
address of the facility.]
for [insert: "taking corrective action" and/or
"compensating third parties for bodily injury and
property damage caused by" either "sudden accidental
releases" or "nonsudden accidental releases" or
"accidental releases"; in accordance with and subject to
the limits of liability, exclusions, conditions, and other
terms of the policy; if coverage is different for different
tanks or locations, indicate the type of coverage
applicable to each tank or location] arising from
operating the underground storage tank(s) identified
above.
The limits of liability are [insert dollar amount of the "per
occurrence" and "annual aggregate" limits of the
Insurer's or Group's liability; if the amount of coverage
is different for different types or for different
underground storage tanks or locations, indicated the
amount of coverage for each type of coverage and/or
for each underground storage tank or location],
exclusive of legal defense costs, which are subject to a
separate limit under the policy. This coverage is
provided under [policy number]. The effective date of
said policy is [date].
2. The ["Insurer" or "Group"] further certifies the
following with respect to the insurance described in
Paragraph 1:
a. Bankruptcy or insolvency of the insured shall not
relieve the ["Insurer" or "Group"] of its obligations under
the policy to which this certificate applies.
b. The ["Insurer" or "Group"] is liable for the payment of
amounts within any deductible applicable to the policy
to the provider of corrective action or a damaged third
party, with a right of reimbursement by the insured for
any such payment made by the ["Insurer" or "Group"].
This provision does not apply with response to that
amount of any deductible for which coverage is
demonstrated under another mechanism or
combination of mechanisms as specified in 40 CFR
§280.95-§280.102.
c. Whenever requested by [a Director of an
Implementing Agency], the ["Insurer" or" Group"]
agrees to furnish to [the Director] a signed duplicate
original of the policy and all endorsements.
d. Cancellation or any other termination of the
insurance by the ["Insurer" or "Group"], except fir non-
payment of premium or misrepresentation of insured,
will be effective only upon written notice and only after
the expiration of 60 days after a copy of such written
notice is received by the insured. Cancellation for non-
payment of premium or misrepresentation by the
insured will be effective only upon written notice and
only after expiration of a minimum of 10 days after a
copy of such written notice is received by the insured.
[Insert for claims-made policies:
e. The insurance covers claims otherwise covered by
the policy that are reported to the ["Insurer" or "Group"]
within six months of the effective date of cancellation or
non-renewal of the policy except where the new or
renewed policy have the same retroactive date or a
retroactive date earlier than that of the prior policy, and
which arises out of any covered occurrence that
commenced after the policy retroactive date, if
applicable, and prior to such policy renewal or
termination date. Claims reported during such
extended reporting periods are subject to the terms,
conditions, limits, including limits of liability, and
exclusions of the policy.]
I hereby certify that the wording of this instrument is
identical to the wording in 40 CFR §280.97(b)(1) and
that the ["Insurer" or "Group"] is ["licensed to transact
the business of insurance or eligible to provide
insurance as an excess or surplus lines insurer in one
or more state."]
[Signature of authorized representative of Insurer or
Risk Retention Group]
[Printed names of person signing]
[Title of person signing], Authorized Representative of
[name of Insurer or Risk Retention Group]
[Address of Representative]
Ust Of Known Insurance Providers For UST Owners And Operators
Page 16
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United States Solid Waste And EPA 510-B-13-001
Environmental Protection Emergency Response July 2013
Agency 5401P www.epa.gov/oust/pubs
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