UNDERGROUND STORAGE TANK POLICY–DESIGNATED TANKS EXPOSURE ANALYSIS CHECKLIST

(November 2022)

INTRODUCTION

This checklist is designed to assist in application of the Insurance Services Office (ISO) Underground Storage Tank Policy–Designated Tanks to a given operation. This is only a starting point and additional risk specific questions may arise as the exposures are developed. This analysis should be combined with exposure analysis checklists for other coverages to develop a complete picture of the insured’s operations.

This checklist is designed to supplement the ACORD application.

A list of endorsements may be helpful as you discuss exposures with your client.

Underground Storage Tank Policy–Designated Tanks Available Endorsements and Their Uses

Underground Storage Tank Policy–Designated Tanks Endorsements Checklist

GENERAL INFORMATION

Legal business name(s):

______________________________________________________________________________________

Mailing address:

______________________________________________________________________________________

Type of entity:

___ Individual	___ Corporation	___ Sub S. Corporation
___ Partnership	___ Joint Venture	___ Other (specify)
___ Not-For-Profit	___ Limited Liability Company

SIC Code(s): _________________________________________________________________________

NAICS Code(s): ________________________________________________________________________

Federal Identification Number: _____________________________________________________________

When did the applicant start business operations? _____________________________________________

When did the present management assume control? ___________________________________________

How many years experience does the owner have in this type of business? __________________________

How many years experience does the manager have in this type of business? ________________________

Has the applicant ever been involved in a bankruptcy procedure? ___ Yes ___ No

If yes, explain including the type of bankruptcy and the filing date: __________________________________

______________________________________________________________________________________

Names of subsidiary companies or joint ventures not included in this application:

______________________________________________________________________________________

____________________________________________________________________________________

Important People	Name Of Applicant Contact	Telephone Number
Owner/Principal
Other Decision Makers
Plant/Grounds
Financial
Legal
Claims

The applicant’s primary operations are: ______________________________________________________

_____________________________________________________________________________________

The applicant’s secondary and incidental operations are:

_____________________________________________________________________________________

The applicant's previous operations now discontinued are:

_____________________________________________________________________________________

Hours of operation: From: ________________________ To: ____________________________________

Number of days each week open for business: _______________________________________________

Is this a seasonal operation? ___ Yes ___ No If yes, what is the season?

From __________________________________ To ___________________________________________

Does the applicant have a formal safety program? ___Yes ___No If yes:

Name of safety director: __________________________________________________________

Safety director telephone number: __________________________________________________

Attach a copy of the safety program.

Does the applicant have a disaster plan? ___ Yes ___ No If yes:

Name of disaster coordinator: ______________________________________________________

Disaster coordinator telephone number: ______________________________________________

Attach a copy of the disaster plan.

TANKS

How many underground storage tanks* does the applicant own or operate? _______

*An underground storage tank is any tank with 10% or more of its volume below ground or grade level. This includes any machinery, equipment, or piping below ground used with the tank.

Provide the following information for each underground storage tank:

Tank Number: _____

Tank location/address: _________________________________________________________________

Tank description: ______________________________________________________________________

Tank type: ___________________________________________________________________________

Tank age: ___________________________________________________________________________

Tank contents: _______________________________________________________________________

Tank construction: Check one:

ÿ Fiberglass or synthetic–with a suction pumping system

ÿ Fiberglass or synthetic–with a pressure pumping system

ÿ Steel–with corrosion protection–including fiberglass coated–with a suction pumping system

ÿ Steel–with corrosion protection–including fiberglass coated–with a pressure pumping system

ÿ Steel–without corrosion protection–including tar-coated–with a suction pumping system

ÿ Steel–without corrosion protection–including tar-coated–with a pressure pumping system

ÿ Not Otherwise Classified (NOC)–with a suction pumping system

ÿ Not Otherwise Classified (NOC)–with a pressure pumping system

ÿ Tanks–above ground

ÿ Other (describe) ______________________________________________________________________

_____________________________________________________________________________________

Protective Devices:

ÿ Only automatic leak detection

ÿ Only automatic overfill protection. This cannot be a collection well.

ÿ Both automatic leak detection and automatic overfill protection

ÿ No protection devices

ÿ All other types of protective devices

Describe all Protective Devices:

_____________________________________________________________________________________

LIMITS OF INSURANCE

The following are the financial responsibility requirements that the Environmental Protection Agency (EPA) established as minimums. Indicate the limits of insurance based on the type of applicant.

Note: The applicant may need higher limits of insurance than the minimums indicated.

Petroleum Marketers producing, refining, or marketing petroleum products:

· Having 100 or fewer tanks. Minimum limits needed: $1,000,000 Incident Limit / $1,000,000 Aggregate Limit