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Home My WebLink AboutInsurance Policies - UST Commerce and Industry (2005-2008) CITY OF RENTON I F E B 01 2000a� City of Renton EIVED Human Resources & Risk Management CITY,CLERK'S OFFICE Memorandum DATE: February 1, 2005 TO: Debbie!Ev. s, Records Management Specialist 1 FROM: lky, HR &RM Admin. Sec. II/Risk Mgmt. Ass't. 1 SUBJECT: Original Insurance Policy For"Underground Storage Tanks" Please find attached, the original insurance policy for the Underground Storage Tanks (UST's)for the policy term 1/1/05— 1/1/06. There are three tanks owned and maintained ' by the City of Renton. l One is located at the Maplewood Golf Course and two are at the City of Renton P/B/PW Maintenance Shops—3555 NE 2nd St. As required by the State of Washington Public Records Retention Act, I am forwarding the original of this policy to you for official retention. Copies have been distributed to ,,Dave Hohn/Fleet Manager and Kelly Beymer/Golf Course Manager. One has also been I retained in my office for risk management purposes. 1,I � Please confirm receipt of this policy and placement in the "vault", via memo. If you have any questions,please do not hesitate to contact me at extension 7661. I i I I it 1,1 1 11 111 I � I � 11 11 1 1 I j I 1 j I 1 CERTIFICATE OF INSURANCE "WE: CITY OF RENTON r2 �o �nIDVE ADDRESS: SEE SCHEDULE BELOW D JAN 1 9 2005 POLICY NUMBER: 7786457 ENDORSEMENT: Not applicable PERIOD OF COVERAGE: January 1, 2005 to January 1, 2006 NAME OF INSURER: Commerce and Industry ADDRESSIOF INSURER: 70 Pine Street New York NY 10270 NAME OF INSURED: CITY OF RENTON ADDRESS OF INSURED: 1055 S GRADY WAY RENTON, WA 98055-3232 11 CERTIFICATION: Commerce and Industry, the Insurer, as identified above,hereby certifies that it has issued liability insurance covering the following underground storage tank(s): See "Item 5. Covered Storage Tank System(s)" on policy referenced above, for taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases in accordance with and subject to the limits of liability, exclusions, conditions and other terms of the policy arising from,operating the underground storage tank(s) identified above. The limits of liability are $1,000,000' each occurrence and $1,000,000 annual aggregate, exclusive' of legal defense costs, which are subject to a separate limit under the policy. This coverage is provided under 7786457. The effective date of said policy is January 1, 2005. 2. The Insurer 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 of its obligations under the policy to 11 which this certificate applies. b. The Insurer is liable for the payment of amounts within any deductible applicable,to the policy to the I provider of corrective! action or damaged third party, with a right of reimbursement by the insured for any such payment made by the Insurer. 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. 1 CI2240 (07/04) INSURED'S COPY • c. Whenever requested by a Director of an implementing agency, the Insurer 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, 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 1i3O days after a copy of such written notice is received by the insured. e. Thei,insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or 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) (2) and that the Insurer is licensed to transact the business of insurance in one or more states. 11 , I Signature of Authorized Representative of Insurer h;n B. Sherlock ' limber Insurance Services, LLC Authorized Representative of Commerce and Industry 1700 Market Street Suite 2000 Philadelphia, PA'19103 • • CI2240 (07/04) 2 - INSURED'S COPY ENDORSEMENT NO. 1 pis endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to:' CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY AIG ENVIRONMENTAL° STORAGE TANK THIRDLPARTY LIABILITY AND CLEAN-UP COSTS POLICY SITE SCHEDULE Site # Facility Name/Address, City, State, Zip 1 P/B/PW 3555 NE 2ND STREET RENTON, WA 98055- 2 MAPLEWOODIGOLF COURSE 4050 MAPLE VALLEY HIGHWAY RENTON, WA 98055- AU)" RIZED REPRESENTATIVE ' or coun L ignature (in states where applicable) I . 81029 (10/02) I ' Page 1 of 1 CI1907 INSURED'S COPY i ENDORSEMENT NO. 2 I his endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to: '' CITY OF RENTON V By: COMMERCE AND INDUSTRY INSURANCE COMPANY I1. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY SCHEDULE OF COVERED STORAGE TANK SYSTEMS It is agreed that any previous Schedule of Covered Storage Tank Systems is deleted in its entirety and replaced with - the following: The following Storage Tank System(s) are included in Item 5. COVERED STORAGE TANK SYSTEM(S) of the Declarations, subject to all of the terms and conditions of the Policy and the Policy Period and 1 Retroactive date indicated below: If no dates are indicated below for Policy Period for a subject Storage Tank System, the dates indicated in Item 2. Policy Period of the Declarations shall apply. If no date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6. Retroactive Date of the Declarations shall apply. If a Policy Period is indicated below for 'a subject Storage Tank System, Item 2. Policy Period of the Declarations is deleted in its entirety and replaced with the Policy Period, below, for such Storage Tank System. If a date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6. Retroactive Date of the Declarationsl 1 is deleted in its entirety and replaced with Retro Date, below, for such Storage Tank System. Site* iI Tank AST/ Install Capacity Tank Policy Period Retro # I # V " UST Date (Gallons) Construction From: To: Date 1 1 UST 1985 12,000 F 01/01/2005 01/01/2006 06/10/1991 1 1, 2 UST 1985 12,000 F 01/01/2005 01/01/2006 06/10/1991 2. . 1 UST 1991 550 DW 01/01/2005 01/01/2006 06/10/1991 *Site #, name and address are located within the Site Schedule attached to the Policy All other terms, conditions, and exclusions shall remain the same AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81017 (10/02) I Page 1 of 1 CI1902 I INSURED'S COPY ill ' COMMERCE AND INDUSTRY INSURANCE COMPANY (Executive Offices) (Administrative Offices) 70 PINE STREET • 175 WATER STREET NEW YORK, N.Y. 10270 NEW YORK, N.Y. 10038 A Capital Stock Company (herein called the "Company") AIG Environmental® STORAGE TANK THIRD-PARTY LIABILITY, CORRECTIVE ACTION AND CLEAN-UP COSTS POLICY DECLARATIONS THIS IS A CLAIMS-MADE AND REPORTED POLICY. PLEASE READ CAREFULLY. POLICY NUMBER: 7786457 Item 1. NAMED INSURED: CITY OF RENTON • ADDRESS: 1055 S GRADY WAY RENTON, WA 98055-3232 Item 2. POLICY PERIOD: FROM January 1, 2005 TO January 1, 2006 12:01 AM Standard Time at the Address of the Named Insured shown above m 3. LIMIT OF LIABILITY: $1,030,000 EACH INCIDENT LIMIT $1,000,000 AGGREGATE LIMIT Item 4. DEDUCTIBLE: $5,000 EACH INCIDENT Item 5. COVERED STORAGE TANKiSYSTEM(S): See Storage Tank Schedule Item 6. RETROACTIVE DATE: June 10, 1991 Item 7. POLICY PREMIUM: $2,332.00 • Premium for Certified Acts of Terrorism Coverage Under Terrorism Risk Insurance Act 2002: $90.00 included in Policy Premium Item 8. FORMS, ENDORSEMENTS AND SCHEDULES ATTACHED TO THIS POLICY: See Attached Form Schedule BROKER: ,Chamber Insurance Agency Services 1700 Market Street, Suite'2000 Philadelphia, PA 19103 46'.9.446: By U A IZED REPRESENTATIVE or count ignature (instates where applicable) 81206 (11/02) Copyright,American International Group, Inc.,2002 Page 1 of 1 CI1948 �', INSURED'S COPY FORMS SCHEDULE Named Insured: CITY OF'RENTON Policy Number: 7786457 Effective 12:01 AM: January 1, 2005 Form Number/ End't. No. Form Name Edition Date Storage Tank Declarations Page 81206 (11/02) Storage Tank Policy , 81106 (10/02) 1 Site Schedule 81029 I (10/02) 2 Schedule of Covered Storage Tank Systems 81017 (10/02) 31, Separation of Insureds Endorsement 81026 ' (10/02) 4 Washington Amendatory Endt 81048 (10/02) 5 ' Limitation of Loss for Certified Acts of Terrorism 81290 (12/02) 6 Change Of Address - Notice To The Company Endt 86357 (07/04) 7 Washington Amendatory Endorsement 78804 (09/01) Notice of Loss/Notice of Claim - CI1141 (09/00) II • 1 CIFMSC CI0226 INSURED'S COPY ENDORSEMENT NO. 1 ,is endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to: CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY AIG ENVIRONMENTAL® STORAGE TANK THIRD-PARTY LIABILITY AND CLEAN-UP COSTS POLICY SITE SCHEDULE Site # Facility Name/Address, City, State, Zip 1 P/B/PW 3555 NE 2ND STREET RENTON, WA 98055- 2 MAPLEWOOD GOLF COURSE 4050 MAPLE VALLEY HIGHWAY RENTON, WA 98055- AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81029 (10/02) Page 1 of 1 CI1907 INSURED'S COPY ENDORSEMENT NO. 2 uis endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to:,' CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY SCHEDULE OF COVERED STORAGE TANK SYSTEMS It is agreed, that any previous Schedule of Covered Storage Tank Systems is deleted in its entirety and replaced with the following: The following Storage Tank System(s) are included in Item 5. COVERED STORAGE TANK SYSTEM(S) of the Declarations, subject to all of the terms and conditions of the Policy and the Policy Period and Retroactive date indicated below. If no dates are indicated below for Policy Period for a subject Storage Tank System, the dates indicated in Item 2. Policy Period of the Declarations shall apply. If no date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6. Retroactive Date of the Declarations shall apply. If a Policy Period is indicated below for a subject Storage Tank System, Item 2. Policy Period of the Declarations is deleted in its entirety and replaced with the Policy Period, below, for such Storage Tank System. If a date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6. Retroactive Date of the Declarations is deleted in its entirety and replaced with Retro Date, below, for such Storage Tank System. Site* Tank AST/ Install Capacity Tank Policy Period Retro # # UST Date (Gallons) Construction From: To: Date 1 1 UST 1985 12,000 F 01/01/2005 01/01/2006 06/10/1991 1 2 UST 1985 12,000 F 01/01/2005 01/01/2006 06/10/1991 2 1 UST. 1991 550 DW 01/01/2005 01/01/2006 06/10/1991 *Site #, name and address are located within the Site Schedule attached to the Policy I All other teiims,'conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81017 (10/02) Page 1 of 1 CI1902 INSURED'S COPY ENDORSEMENT NO. 3 its endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to: CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SEPARATION OF INSUREDS CONDITION ENDORSEMENT It is hereby agreed that the Policy is amended by the addition of the following condition to Section VI. CONDITIONS: 11 Separation 'of Insureds - It is hereby agreed that except with respect to the Limit of Liability, Section II. E. (Insured vs. Insured exclusion), and any rights and duties specifically assigned to the first Named Insured, this insurance applies: 1. As if leachNamed Insured were the only Named Insured; and 2. Separately to each Named Insured against whom a Claim is made. Misrepresentation, concealment, breach of a term or condition, or violation of any duty under this Policy by one Named Insured shall not prejudice- the interest of coverage for another Named Insured under this Policy. Provided, however, that this Condition shall not apply to any Named Insured who is a parent, subsidiary or affiliate of the first Named Insured. - • All other terms, conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE • or countersignature (in states where applicable) 81026 (10/02) PAGE 1 OF 1 CI1904 11 INSURED'S COPY ENDORSEMENT NO. 4 its endorsement, effective 12:01 AM, January 1, 2005 I Forms a part of Policy No: 7786457 Issued to: CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON AMENDATORY ENDORSEMENT It is hereby I agreed that the Policy is amended as follows: 1. The second sub-paragraph of Section VI. CONDITIONS, Paragraph B. Subrogation, is deleted in its entirety and replacetl with the following: In the event of any recovery by the Company as result of subrogation proceedings arising out of a Loss, Clean-Up Costs or Corrective Action covered under this Policy, the Company shall, from the funds collected, first pay to the Insured the applicable deductible paid by the Insured less the prorated share of subrogation expenses and only thereafter retain any funds in excess of the deductible portion of the recovery. 2. Section(VI. CONDITIONS, Paragraph N. Choice of Law, is deleted in its entirety. 11 111 I i All other terms, conditions, and exclusions shall remain the same. li AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81048 (10/02) PAGE 1 OF 1 CI1926 INSURED'S COPY ENDORSEMENT NO. 5 endorsement, effective 12:01 AM, January is 1, 2005 Forms a part of Policy No: 7786457 Issued to: 'I CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITATION OF LOSSES FOR CERTIFIED ACTS OF TERRORISM Our liability for loss, injury, damage, claim or suit, arising directly or indirectly as a result of or in connection with a certified "act of,terrorism" defined by Section 102. Definitions., of the Terrorism Risk Insurance Act of 2002 (the Act), and any revisions or amendments, is limited by Section 103. Terrorism Insurance Program, of the Act. • • • If I All other terms,, conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81290 (12/102) Page 1 of 1 CI1980 INSURED'S COPY r ENDORSEMENT NO. 6 Isis endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to: I CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGE OF ADDRESS - NOTICE TO THE COMPANY ENDORSEMENT It is hereby,agreed that anywhere in the Policy that the address of the Company is set forth as 80 Pine Street, Sixth Floor, New York, NY 10005, Fax (212) 344-2761 such address is deleted in its entirety and replaced with the following: AIG Technical Services, Inc. Environmental Claims 101 Hudson St. - 31st Floor Jersey City, NJ,07302 Fax: 201-631-5051 j • • • ij • All other terms, conditions, and exclusions shall remain the same. j r • AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 86357 (7/04) I PAGE 1 OF 1 CI2348 INSURED'S COPY ENDORSEMENT NO. 7 pis endorsement, effective 12:01 AM, January 1, 2005 Forms a part of Policy No: 7786457 Issued to: CITY OF RENTON By: COMMERCE AND INDUSTRY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ' WASHINGTON CANCELLATION/NONRENEWAL AMENDATORY ENDORSEMENT • Wherever used 'in this endorsement: 1) "we", "us", "our", and "Insurer" mean the insurance company which issued this policy; and 2) "you", "your", "Named Insured", "First Named Insured", and "Insured" mean the Named Corporation, Named Organization, Named Sponsor, Named Insured, or Insured stated in the declarations page; and 3) "Other Insured(s)" means all other persons or entities afforded coverage under the policy. The cancellation provisions in the policy are changed as follows: A. CANCELLATION 1. The Insured may cancel this policy by mailing or delivering to the Insurer advance written notice of cancellation or by surrender of the policy prior to or on the effective date of such cancellation. 2. The Insurer may cancel this policy by mailing or delivering to the Insured and the Insured's representative in charge of the subject of the insurance, if applicable, written notice of cancellation, including the actual reason for the cancellation, to the last mailing address known to the Insurer, at least: a. 10 days before the effective date of cancellation if the Insurer cancels for nonpayment of premium; or b. 45 days before the effective date of cancellation if the Insurer cancels for any other reason. 3. Like notice of cancellation will also be mailed to any mortgage holder, pledgee or other person shown in this policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If notice is mailed, proof of mailing will be sufficient proof of notice. 6. When an insurance contract is not financed and canceled by an Insured, then the return premium shall be calculated short rate (pro rata x..90). B. NONRENEWAL 1. The Insurer may elect not to'renew this policy by mailing or delivering written notice of nonrenewal, to the First Named Insured and the First Named Insured's representative in charge of the subject of the.insurance at their respective last mailing addresses known to the Insurer. The notice of nonrenewal shall state the actual reason for 'nonrenewal. The Insurer will also mail to any mortgage holder or other person shown in this policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer, written notice of nonrenewal. The Insurer will mail or deliver these notices at least 45 days before the: a. i Expiration of the policy; or 78804 (9/01) PAGE 1 OF 2 CI2170 INSURED'S COPY I ENDORSEMENT NO. 7 (Continued) b. Anniversary date of this policy if this policy has been written for a term of more than one year. Otherwise, the Insurer will renew this policy unless: a. 'The Insured Insured fails to pay the renewal premium after the Insurer has expressed willingness to renew and has sent a statement of the renewal premium to the Insured and the Insured's representative in charge of the subject of insurance at least 20 days before the expiration date;. b. Other equivalent coverage has been procured by the Insured prior to the expiration date of the policy; or c. The contract is evidenced by a written binder containing a clearly stated expiration date which has expired according to its terms. II • ' I I , All other terms l conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 78804 (9/01) - PAGE 2 OF 2 CI2170 INSURED'S COPY AIG ENVIRONMENTAL II I NOTICE OF LOSS/NOTICE OF CLAIM '"c7RUCTIONS: PLEASE ATTACH ALL CORRESPONDENCE RELATING TO THIS NOTICE OF LOSS AND MAIL DIES OF THIS NOTICE TO THE ADDRESS BELOW: Manager, Pollution Insurance Products Unit AIG Technical Services, Inc. Environmental Claims Department 101 Hudson Street, 31 st Floor Jersey City, NJ 07302 Date of Notice` i NAMED INS4RED: CITY OF RENTON ADDRESS OF INSURED: 1055 S GRADY WAY RENTON, WA 98055-3232 TELEPHONE,: ( ) CONTACT: BROKER NAME: Chamber Insurance Agency Services BROKER ADDRESS: 1700 Market Street, Suite 2000 Philadelphia, PA 19103 `z_PHONEE: ( ) TACT: POLICY INFORMATION: Policy Number: 7786457 Policy Period:l From: January 1, 2005 To: January 1, 2006 Loss Information: Loss Location: Date & DescriP tion of Loss: 11 For AIG Use Only: Date Claim Notice Received: ^^a^ of Claim: 'pany/Person Filing Suit (if applicable): NOTE: Any person who knowingly files a Statement of Claim containing any.false or misleading information is subject to criminal and civil penalties. CI1141 (09/00) INSURED'S COPY I AMERICAN INTERNATIONAL COMPANIES ® I AIG ENVIRONMENTAL® STORAGE TANK THIRD-PARTY LIABILITY, CORRECTIVE ACTION AND CLEAN-UP 1. COSTS POLICY POLICY. PLEASE READ CAREFULLY. ADDITIONALLY, THIS IS A CLAIMS-MADE-AND-REPORTED , THIS POLICY HAS CERTAIN PROVISIONS AND REQUIREMENTS UNIQUE TO IT AND MAY 'BE DIFFERENT FROM OTHER POLICIES THE INSURED MAY HAVE PURCHASED. DEFINED TERMS, OTHER THAN HEADINGS, APPEAR IN BOLD FACE TYPE. 11 THE DESCRIPTIONS IN ANY HEADINGS OR SUB-HEADINGS OF THIS POLICY ARE INSERTED SOLELY FOR CONVENIENCE AND DO NOT CONSTITUTE ANY PART OF THE TERMS OR CONDITIONS HEREOF. In consideration of the payment of the premium, in reliance upon the statements in the Declarations and the Application, annexed hereto and made a part of this Policy or, if not annexed hereto, which are deemed to be annexed hereto and made a part of this Policy, and pursuant to all of the terms of this Policy, the Company agrees with the Named Insured as follows:. I. INSURING(AGREEMENT 1. COVERAGES: COVERAGE A - THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE DUE TO A STORAGE TANK RELEASE To payl on behalf of the Insured, Loss that the Insured becomes legally obligated to pay as a result of Claims for BodilyI,lnjury or Property Damage resulting from Pollution Conditions from a covered Storage;Tank System, provided such Claims are first made against the Insured and reported to the Company in writing during the Policy Period or during the Extended Reporting Period, if applicable. The Pollution Condition must,commence on or after the Retroactive Date as shown in Item 6 of the Declarations. COVERAGE B CLEAN-UP COSTS OR CORRECTIVE ACTION DUE TO A STORAGE TANK RELEASE To pay" on behalf of the Insured, Clean-Up Costs or Corrective Action that the Insured becomes legally obligated to pay as a result of a Confirmed Release from a covered Storage Tank System, provided such Confirmed) Release is first reported to the Company in writing during the Policy Period or during the Extended Reporting Period, if applicable. The Pollution Condition must commence on or after the Retroactive Date as shown lin Item 6 of the Declarations. 2. DEFENSE: The Company shall have the right and duty to defend any Claims covered under Coverage A, or any civil or administrative proceedings or suits which seek to impose a legal obligation upon the Insured to undertake Clean-Up Costs or Corrective Action for a Confirmed Release to which Coverage B applies. The Company's duty to defend or continue defending any such Claims, civil or administrative proceedings or suits and to pay any Loss, Corrective Action, Clean-Up Costs or defense costs, charges and expenses, shall cease once the applicable limit of liability, as described in Section V. LIMITS OF LIABILITY AND DEDUCTIBLE, has been exhausted. 3. INDEPENDENT COUNSEL: In the event the Insured is entitled by law to select independent counsel to defend the Insured at the Company's expense, the attorney fees and all other litigation expenses the Company must pay to that counsel are limited to the rates the Company would actually pay to counsel that the Company retains in the ordinary course of business in the defense of similar Claims in the'community where the Claim arose or is being defended. J , 81106 (10/02) 1 CI1941 I INSURED'S COPY Additionally, the Company may exercise the right to require that such counsel have certain minimum qualifications with respect to their competency, including experience in defending Claims similar to the one pending against the Insured;! and to require such counsel to have errors and omissions insurance coverage. As respects any such counsel,the Insured agrees that counsel will timely respond to the Company's request for information regarding the Claim. The Insured may at any time, by its signed consent, freely and fully waive its right to select independent counsel.,, 4. SETTLEMENT: The Company will present any settlement offers to the Insured, and if the Insured refuses to consent to any settlement within the limits of liability of this Policy recommended by the Company and acceptable to the claimant, the Company's duty to defend the Insured shall then cease and the Insured shall thereafter negotiate or defend such Claim,independently of the Company and the Company's liability shall not exceed the amount, less the Deductible or any outstanding Deductible balance, for which the Claim could have been settled if such recommendation was consented to. II. EXCLUSIONS 1. COMMON EXCLUSIONS - APPLICABLE TO ALL COVERAGES: This Policy does not apply to Claims, Clean-Up Costs or Corrective Action, or Loss: A. CRIMINAL FINES, PENALTIES, AND ASSESSMENTS: i Due to any criminal fines, criminal penalties or criminal assessments. B. CONTRACTUAL LIABILITY: Arising from liability-of others assumed by the Insured under any contract or agreement, unless the liability of the Insured would have attached in the absence of such contract or agreement or the contract or (agreement is an Insured Contract. C. INTENTIONAL NONCOMPLIANCE: Arising from Pollution Conditions based upon or attributable to any Responsible Insured's intentional, Willful or deliberate noncompliance with any statute, regulation including those set forth in Title 40 of the Code of Federal Regulations, ordinance, administrative complaint, notice of violation, notice letter, executive ('order, or instruction of any governmental agency or body. D. INTERNAL EXPENSES: ,For,costs, charges or expenses incurred by the Insured for goods supplied or services performed by the staff or salaried employees of the Insured, or its parent, subsidiary or affiliate, except if in response to an Jemergency or pursuant to Environmental Laws that require immediate remediation of Pollution Conditions, or unless such costs, charges or expenses_areincurred with the prior written, approval of the Company in its sole discretion. E. ,INSURED vs. INSURED: • Arising from a Claim brought by any Insured against any other person or entity who is, also an Insured under this Policy. This exclusion does not apply to Claims initiated by third parties or Claims that arise out of an indemnification given by one Named Insured to another Named Insured in an Insured Contract. F. EMPLOYER LIABILITY: , Arising from Bodily Injury to an Insured or its parent, subsidiary or affiliate arising out of arid in the course of employment by the Insured or its parent, subsidiary or affiliate. This exclusion applies whether the Insured may be liable as an employer or in any other capacity and to any obligation_to share damages with or repay third parties who must pay damages because of the injury. 81106 (10/02) 2 CI1941 II INSURED'S COPY G. PRIOR KNOWLEDGE/NON-DISCLOSURE: Arising from Pollution Conditions existing prior to the Inception Date and known by al Responsible Insured and not disclosed in the application for this Policy, or any previous policy for which this Policy is a renewal thereof. H. COST TO CONFIRM A RELEASE FROM A STORAGE TANK SYSTEM: For any costs, charges or expenses incurred to investigate or certify that a Confirmed Release has taken place. I. bOST TO REPAIR, REPLACE OR UPGRADE A STORAGE TANK SYSTEM: ' jFor any costs arising out of the reconstruction, repair, replacement, upgrading or rebuilding of any Storage Tank System or for any other improvements, site enhancements or routine maintenance on, within or under the site at which Storage Tank Systems are located. J. DIVESTED STORAGE TANK SYSTEMS OR SITES: Arising from Pollution Conditions or Confirmed Releases which commence after the date)that a covered Storage Tank System, or the site at which the Storage Tank System is located, is sold, given away, labandoned, or subleased, unless the sublease has been approved in writing by the underwriter prior to the 'commencement of the sublease. - K. ISTORAGE TANK SYSTEM CONTENTS: H. 'Arising from physical' injury, including but not limited to contamination, of the contents of a Storage Tank System; or '2. ;Arising out of Property Damage due to physical injury, including but not limited to contamination, of the -• [contents of a Storage Tank System; or ;3. For any costs arising out of the removing, replacing or recycling of the contents of any, Storage Tank II System. L. WAR ',Arising directly or indirectly as a result of or in connection with war, whether declared or Inot, or any act or condition incident to war. War includes civil war, insurrection, act of foreign enemy, civil commotion, 1 factional civil commotion,.military or usurped power, rebellion or revolution. III. NOTICE REQUIREMENTS AND CLAIM PROVISIONS The Insured shall provide the Company with notice of Confirmed Release, Claim and Pollution Conditions, as follows: 1. ' In the event of a Confirmed Release, Claim or Pollution Condition, the Insured shall give written notice to: - Manager, Pollution Insurance.Products Unit AIG Technical Services, Inc. Environmental Claims Department 80 Pine Street, Sixth Floor New York, New York 10005 Fax: (212) 344-2761 or other address(es) as substituted by the Company in writing. 11 81106 (10/02) 3 CI1941 INSURED'S COPY 2. The Insured shall give written notice of Claims, a Confirmed Release or Pollution Conditions as soon as possible, but in any event during the Policy Period or during the Extended Reporting Period, if applicable. Notice under all coverages shall include, at a minimum, information sufficient to identify the Named Insured, the Storage Tank System, the names of persons with knowledge of the Pollution Conditions and all known and reasonably obtainable information regarding the time, place,cause, nature of and other circumstances of the Pollution Conditions. The Insured shall forward the following to the Company as soon as possible: 1 (a) All reasonably obtainable information with respect to the time, place and circumstances'thereof, and the names and addresses of the claimant(s) and available witnesses; (b) All correspondence between the Insured and any third party Claimant, including but not;limited to any Implementing Agency; and all demands, summonses, notices or other process or papers filed with a ! court of law, administrative agency, Implementing Agency or an investigative body; and . (c) Other information in the possession of the Insured or its hired experts which the Company reasonably deems necessary. IV. RIGHTS IOF THE COMPANY AND DUTIES OF THE INSURED IN THE EVENT OF POLLUTION CONDITIONS A. The Company's Rights The Company shall have the right but not the duty to clean up or mitigate Pollution Conditions upon receiving notice as provided in Section III. of this Policy. Any sums expended in taking such action by the Company will be deemed incurred or expended by the Insured and shall be applied against the limits of liability and deductible under this Policy. B. Duties of the Insured J The 'Named Insured shall have the duty to clean up Pollution Conditions to the extent 'required by Environmental Laws, by retaining competent professional(s) or contractor(s) mutually acceptable to the ' Company and the Named Insured. The Company shall have the right but not the duty to review and approve all aspects of any such clean-up. The Named Insured shall notify the Company of actions and measures taken pursuant to this Paragraph. V. LIMITS OF LIABILITY AND DEDUCTIBLE • Regardless of the number of Claims, Claimants, Confirmed Releases, Pollution Conditions or Insureds under this Policy, the following limits of liability apply: A. Coverage A and B Aggregate The Company's total liability for all Loss covered under Coverage A and Clean-Up Costs and Corrective Action covered under Coverage B shall not exceed the "Aggregate Limit" stated in Item 3 of the Declarations. B. Each Incident Limit - - Subject to Paragraph V.A. above, the most the Company will pay for all Loss and Clean-Up Costs and Corrective Action arising from the same, related or continuous Pollution Conditions is the "Each Incident" limit!of coverage stated in Item 3 of the Declarations. "Each Incident" as used within this Policy shall mean each same, related or continuous Pollution Condition. C. Related Claims 1. .If the Insured first reports a Claim, Confirmed Release or discovers Pollution Conditions during the Policy Period and reports them to the Company in accordance with Section III., all continuous or related !Pollution Conditions reported to the Company under a subsequent policy issued by the Company or its affiliate providing substantially the same coverages as this Policy shall be deemed to have been first 'discovered and reported during this Policy Period and shall be subject to the same Limit of Liability. I 81106 (10/02) 4 CI1941 • INSURED'S COPY made duringone or more policyperiods issued bythe 2. All Claims and reports of Confirmed Releases Company or its affiliate providing substantially the same coverages, resulting in Loss, or Clean-Up Costs or Corrective Action, or'in any combination thereof, and arising out of the same, or continuous or related Pollution Conditions, shall be considered one incident and will be subject to the same Limit of Liability. Such Claims or reports of Confirmed Releases shall be deemed first reported to the Company during the policy period in which the first such Claim or report of Confirmed Release was reported' to the Company or an affiliate and will be subject to the Limit of Liability applicable to that policy period. D. Deductible Subject to Paragraphs V. A. and V. B. above, this Policy will pay Clean-Up Costs, Corrective Action or Loss in excess of the Deductible amount stated in Item 4 of the Declarations up to but not exceeding the applicable "Each Incident" limit of coverage. The Insured shall promptly reimburse the Company for advancing any element .of Clean,Up Costs or Corrective Action or Loss falling within the Deductible. VI. CONDITIONS - - A. Assignment - This Policy may be assigned with the prior written consent of the Company, which consent shall not,be unreasonably withheld or delayed. Assignment of interest under this Policy shall not bind the Company until its consent is endorsed thereon. B. Subrogation - In the event of any payment under this Policy, the Company shall be subrogatod to all the Insured's rights of recovery therefor against any person or organization and the Insured shall execute and deliver ''instruments and papers and do whatever else is necessary to secure such rights including without limitation, assignment of the Insured's rights against any person or organization who caused Pollution Conditions on account of which the Company made any payment under this Policy. The;Insured shall do } nothing to prejudice the Company's rights under,this Paragraph subsequent to Loss. Any recovery as a result of subrogation proceedings arising out of the payment of Loss, Clean-Up Costs or Corrective Action covered under this Policy shall accrue first to the Insured to the extent of any payments in excess of the limit of coverage; then to the Company to the extent of its payment under the Policy; and then to the Insured to the extent of its Deductible. Expenses incurred in such subrogation proceedings shall be apportioned among the interested parties in the recovery in the proportion that each interested party's share in the recovery bears to the total recovery. C. Cooperation - The Insured shall cooperate with the Company and offer all reasonable ,assistance in the investigation and defense of Claims under the applicable Coverages purchased. The Company may require that the; Insured submit to examination under oath, and attend hearings, depositions and trials. In the course of investigation or defense, the Company may require written statements or the Insured's attendance at meetings with the Company. The Insured must assist the Company in effecting settlement, securing and providing evidence and obtaining the attendance of witnesses. D. Changes - Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this Policy or estop the Company from asserting any rights under the terms of this Policy; nor shall the terms of this Policy be waived or changed, except by endorsement issued by the Company to form a part of this Policy. E. Voluntary Payments - No Insured shall voluntarily enter into any settlement, or make any payment or assume any obligation unless in response to an emergency or pursuant to Environmental Laws that;require immediate remediation of Pollution Conditions, without the Company's consent which shall not be unreasonably withheld, excepfat the Insured's owns cost. ' ' i 81106 (101/02) 5 CI1941 INSURED'S COPY F. Concealment or Fraud - This entire Policy shall be void if, whether before or after Clean-Up Costs or Corrective Action are incurred or a Claim is first made, the Named Insured has willfully concealed or misrepresented any fact or circumstance material to the granting of coverage under this Policy, including but not limited to, the description of the Storage Tank System, or the interest of the Insured therein. G. Cancellation - This Policy may be cancelled by the Named Insured by surrender thereof to the Company or any of its authorized agents ors by mailing to the Company written notice stating when thereafter the cancellation shall be effective. This Policy may be cancelled by the Company only for the reasons stated below by mailing to the Named Insured at the address shown in the Policy, written notice stating when, not less than 60 days (10 days, for'nonpayment of premium or material misrepresentation by the Insured), thereafter such cancellation shall;be effective. Proof of mailing of such notice shall be sufficient proof of notice. 1. Material misrepresentation by the Insured; 2. The Insured's failure to comply with the material terms, conditions or contractual obligations under this Policy, including failure to pay any premium when due; 11 3. A change in operations at a facility containing a Storage Tank System during the Policy Period that materially increases a risk covered under this Policy. The ;time of surrender or the effective date and hour of cancellation stated in the notice shall become the end of the Policy Period. Delivery of such written notice either by the Named Insured or by the Company shall be equivalent to mailing. If the Named Insured cancels, earned premium shall be computed in accordance with the 'customary short rate table and procedure. If the Company cancels, earned premium shall be computed pro-rata. Premium adjustment,may be either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. H. Other Insurance - If other valid and collectible insurance or funds from any Tank Fund are available to the - Insured for Loss, Clean-Up Costs or Corrective Action covered by this Policy, the Insured shall promptly, upon the request of the Company, provide the Company with copies of all such policies or fund documentation. The Company's obligations are limited as follows: 1. 'Except as set forth in subparagraph 3. of this Paragraph, this insurance is primary, and the Company's obligations are not affected unless any of the other insurance is also primary. In that case, the Company will share with all such other insurance by the method described in Paragraph 2. below. 2. If all of the other insurance permits contribution by equal shares, the Company will follow this method also. (Under this approach each insurer contributes equal amounts until it has paid its applicable'limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, the Company will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all 'insurers. 3. This insurance shall apply as excess insurance over any Tank Fund, provided that in the event of the �receivership, insolvency, or inability to pay of any state fund or program, this insurance shall act as primary insurance. Where this insurance is excess, the Company will pay only its share of the amount of Loss, (;Clean-Up Costs or Corrective Action, if any, that exceeds the total amount available through the Tank 'Fund. I. Right of Access and Inspection - To the extent the Insured has such rights, any of the Company's authorized representatives shall have the right and opportunity but not the obligation to interview persons employed by the Insured and to inspect at any reasonable time, during the Policy Period or thereafter, the Storage Tank System or the site at which the Storage Tank System is located. Neither the Company nor its representatives shall assume any responsibility or duty to the Insured or to any other party, person or entity, by reason of such right or inspection. Neither the Company's right to make inspections, sample' and monitor, nor the factual undertaking thereof nor any report thereon shall constitute an undertaking on behalf of the Insured or 81106 (10/02) ' 6 CI1941 , INSURED'S COPY others, to determine or warrant that property or operations are safe, healthful or conform to acceptable engineering practices or are in compliance with any law, rule or regulation. The Named Insured agrees to provide appropriate personnel to assist the Company's representatives during any inspection. I Access[to Information - The Named Insured agrees to provide the Company with access to any information developed or discovered by the Insured concerning Loss, Clean-Up Costs or Corrective Action, or Pollution Conditions covered under this Policy, whether or not deemed by the Insured to be relevant to such Loss, Clean-Up Costs or Corrective Action, or Pollution Conditions and to provide the Company access to interview any Insured and review any documents of the Insured. K. Representations - By acceptance of this Policy, the Named Insured agrees that the statements in the Declarations, the Application and, if applicable, the ReportNVorksheet are their warranties, agreements and representations, that this Policy is issued in reliance upon the truth of such warranties, agreements and representations and that this Policy embodies all agreements existing between the Insured and the Company or any'of its agents relating to this insurance. L. Action Against Company - No third-party action shall lie against the Company, unless as a condition precedent thereto there shall have been full compliance with all of the terms of this Policy, nor until the amount of the Insured's obligation to pay shall have been finally determined either by judgment against the Insured after actual trial or by written agreement of the Insured, the claimant and the Company. Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this Policy to the extent of the insurance afforded by the Policy. No person or organization shall have any right under this Policy to join the Company as a party to any action against the Insured to determine the Insured's liability, nor shall the Company be impleaded by the Insured or his legal representative. Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company of any of its obligations hereunder. M. Arbitration - It is hereby understood and agreed that all disputes or differences that may arise under or in connection with this Policy, whether arising before or after termination of this Policy, including any determination of the ;amount of Loss, may be submitted to the American Arbitration Association ("AAA") under and in accordance with the United States Arbitration Act (9 U.S.C.) and the then prevailing commercial arbitration rules of the AAA. The arbitrators shall be chosen in the manner and within the time frames provided by such rules. If permitted under such rules, the arbitrators shall be three disinterested individuals having knowledge of the legal, corporate management, or insurance,issues relevant to the matters in dispute. Any party may commence such arbitration proceeding and the arbitration shall be conducted in the Insured's state of domicile. The arbitrators shall give due consideration to the general principles of 'the law of the Insured's state of domicile in the construction and interpretation of the provisions of this Policy; provided, however, that the terms, conditions, provisions and exclusions of this Policy are to be' construed in an evenhanded fashion as between the parties. Where the language of this Policy is alleged to be ambiguous or otherwise unclear, the issue shall be resolved in the manner most consistent with the relevant'terms, conditions, provisions or exclusions of the Policy (without regard to the authorship of the language, the doctrine of reasonable expectation of th'e parties and without any presumption or arbitrary interpretation or construction in favor of either party or parties, and in accordance with the intent of the parties). The written decision of the'arbitrators shall set forth its reasoning, shall be provided simultaneously to both parties;and shall be binding on- them. The arbitrators' award shall not include attorney fees or other costs. Judgment on the award may be entered in any court of competent jurisdiction. Each party shall bear equally the expenses of the arbitration. N. Choice of Law - In the event that the Insured and the Company dispute the validity or formation of this Policy or the meaning, interpretation or operation of any term, condition, definition or provision of this Policy resulting in litigation, arbitration or other;form of dispute resolution, the Insured and the Company agree that the law of the State of New York shall apply. 81106 (10/02) 7 CI1941 ' INSURED'S COPY of Shared Limits - Byacceptance of this Policy, the Named Insureds understand, agree O. Acknowledgment p Y and 'acknowledge that the Policy contains an Aggregate Limit that is applicable to, and will be shared by, all Named Insureds and all other Insureds who are or may become insured hereunder. In view of the operation and nature of this shared Aggregate Limit, the Named Insureds and all other Insureds understand and agree that prior to filing a Claim or reporting a Confirmed Release under the Policy, the Aggregate Limit may be exhausted or reduced by prior payments for other Claims, Clean-Up Costs or Corrective Action under the Policy. VII. EXTENDED REPORTING PERIOD FOR CLAIMS The Named Insured shall be entitled to an Automatic Extended Reporting Period, and (with certain exceptions as described in Paragraph B. of this Section) be entitled to purchase an Optional Extended Reporting Period for any Coverages terminated, upon termination of coverage as defined in Paragraph B.3. of this Section. Neither the Automatic nor the Optional Extended Reporting Period shall reinstate or increase any of the Limits of Liability of this Policy. A. Automatic Extended Reporting Period Provided that the Named Insured has not purchased any other insurance to replace this insurance and which applies to a Claim or a Confirmed Release otherwise covered hereunder, the Named Insured shall have the right to the following: a period of six (6) months following the effective date of such termination of coverage in which to provide written notice to the Company of a Claim first made during the Policy Period or Automatic Extended Reporting Period and first reported within the Automatic Extended Reporting Period, or Confirmed Release first reported within-the Automatic Extended Reporting Period. A Claim first made during the Policy Period or Automatic Extended Reporting Period and first reported within the Automatic Extended Reporting Period, or Confirmed Release first reported within the Automatic Extended Reporting Period will be deemed to have been made on the last day of the Policy Period, provided that the Claim or Confirmed Release arises from Pollution Conditions that commenced before the end of the,Policy Period and is otherwise covered by this Policy. No part of the Automatic Extended Reporting Period shall apply if the Optional Extended Reporting Period is purchased. B. OptIonal Extended Reporting Period The Named Insured shall be entitled to purchase an Optional Extended Reporting Period upon termination of coverage as defined herein (except in the event of nonpayment of premium), as follows: 1. 'A Claim first made during the Policy Period or during the Optional Extended Reporting Period and first reported during the Optional.Extended Reporting Period, or a Confirmed Release first reported within the ,,Optional Extended Reporting Period, if purchased in accordance with the provisions contained in ,Paragraph 2. below, will be deemed to have been made on the last day of the Policy Period, provided that. the Claim or Confirmed Release arises from Pollution Conditions that commenced before the end of the 1Policy Period and is otherwise covered by this Policy. 2. The Company shall issue an endorsement providing an Optional Extended Reporting Period of up to forty (40) months from termination of coverage hereunder for all Storage Tank Systems, or for a Storage Tank System located at a specific facility, provided that the Named Insured: (a) makes a written request for such endorsement which the Company receives within sixty (60) days after termination of coverage as defined herein; and (b) pays when due an amount equal to the premium for the Optional Extended Reporting Period plus any premium for the Policy Period which is owed and has not yet been paid. If these premiums are paid when due, the Extended Reporting Period may not be cancelled, provided that all other terms and conditions of the Policy are met. 81106 (10/02) 8 CI1941 INSURED'S COPY i 3. 'Termination of coverage occurs: (a) at the end of the Policy Period, or (b) at the time the Policy or renewal policy becomes effective with a decrease in the limit of liability, a reduction of coverage, an increased deductible or self-insured retention, new exclusion or any other change in coverage less favorable to the Insured. 4. They Optional Extended Reporting Period is available to the Named Insured for not more than 100% of the policy premium of this Policy. VIII. DEFINITIONS A. Bodily Injury means physical injury, or sickness, disease, mental anguish or emotional distress sustained by any person including death resulting therefrom. B. Claim means a written demand received by an Insured seeking a remedy and alleging liability or responsibility on the part of the Insured for Loss. C. I Clean-Up Costs means: Reasonable and necessary expenses for the investigation, removal or remediation of Pollution Conditions including associated monitoring, or disposal of soil, surfacewater, groundwater or other it contamination: (a) To the extent required by Environmental Laws; or (b) That have been actually incurred by the government or any political subdivision of the United 11 States of America or any state thereof or Canada or any province thereof, or by third parties. Clean-Up Costs also include Restoration Costs. D.i Confirmed Release means Pollution Conditions from a Storage Tank System, including those from an overfill of a Storage Tank System, that has been investigated and confirmed by or on behalf of the Insured during the Policy Period through a system tightness test, site check, or other procedure approved by the Implementing Agency in accordance with Environmental Law. E. Corrective Action means: 1. Reasonable and necessary costs for response, abatement, investigative, and removal actions resulting from a Confirmed Release as legally required by Subpart F of the federal underground storage tank regulations, 40 C.F.R. 280.60 through 280.66, and 280.72, or as legally required by other applicable ' federal regulations or by other applicable regulations promulgated by a state under an underground storage tank program approved by the United States Environmental Protection Agency in accordance with Section 9004 of the Resource Conservation and Recovery Act of 1976, as amended; 2. , Reasonable and necessary costs for the cleanup, pursuant to a written order from the Implementing I Agency and with the prior written approval of the Company, of Pollution Conditions in soil or groundwater due to a Confirmed Release, including the preparation, development, modification and implementation of a "corrective action plan" as defined in 40 C.F.R. 280.66, and the monitoring, evaluation and reporting of the results of the implementation of such plan. F.!' Environmental Laws means any federal, state, provincial or local laws (including, but not limited to, statutes, rules, regulations, ordinances, guidance documents, and governmental, judicial or administrative orders and directives) that are applicable to Pollution Conditions. G.I Extended Reporting Period means either the automatic additional period of time or the optional additional period of time, whichever is applicable, in which to report Claims or Confirmed Releases following I termination of coverage, as described in Section VII. of this Policy. 81106 (10/02) 9 CI1941 INSURED'S COPY I ' H. Implementing Agency means the Federal Environmental Protection Agency or a state 'or local agency having jurisdiction pursuant to Environmental Laws. I. Inception Date means the first date set forth in Item 2 of the Declarations. J. Insured means the Named Insured, and any past or present director, officer, partner or employee thereof, including a temporary or leased employee, while acting within the scope of his or her duties as such. K. Insured Contract means,a contract or agreement submitted to and approved by the Company, and listed on a Scheduled Insured Contract Endorsement to this Policy. L. Loss means, under the applicable Coverages: 1. Monetary awards or settlements of compensatory damages; where allowable by law, punitive, exemplary, or multiple damages; and civil fines, penalties, or assessments for Bodily Injury or Property Damage; or 2. Clean-Up Costs or Corrective Action. M. Named Insured means the person or entity named in Item 1 of.the Declarations acting on ;behalf of all other Insureds, if any, for the payment or return of any premium, payment of any deductible, receipt and acceptance of any endorsement issued to form a part of this Policy, giving and receiving notice of cancellation or nonrenewal, and the exercise of the rights provided in the Extended Reporting Period jclause. I N. 'Policy Period means the period set forth in Item 2 of the Declarations, or any shorter period arising as a ;result of: 1. Cancellation of this Policy; or .2. With respect to particular Storage Tank System(s): I I (a) the deletion or addition of such Storage Tank System from this Policy by the' Company at the Named Insured's written request, but solely with respect to that Storage Tank System. (b) the sale, giving away or abandonment of a Storage Tank System, or the sub-leasing of such Storage Tank System, unless the sub-lease has been approved in writing by the;Company prior to the commencement of the sub-lease. O. Pollution Conditions means the discharge, dispersal, release or escape of any solid, liquid, gaseous or ',thermal irritant or contaminant, including,but not limited.to, smoke, vapors, soot, fumes, acids,.alkalis, toxic chemicals, medical waste and waste materials into or upon land, or any structure on land, the atmosphere ;;or any watercourse or body of water, including groundwater, provided such conditions are ,not naturally 'present in the environment in the amounts or concentrations discovered. P. 'Property Damage means: 1. ;Physical injury to ordestruction of tangible property of parties other than the Insured including the resulting loss of use thereof; 2. Loss of use of tangible property of parties other than the Insured that has not been physically injured or destroyed; Property Damage does not include Clean-Up Costs or Corrective Action. Q. rl Responsible Insured means the manager or supervisor of the Named Insured responsible for environmental affairs, control or compliance, or any owner or operator of a Storage Tank System, or any j officer, director or partner of the Named Insured. j 81106 (10/02) 10 CI1941 � I INSURED'S COPY . R. 1Restoration Costs means reasonable and necessary costs incurred by the Insured with the Company's written consent, which consent shall not be unreasonably withheld or delayed, to repair, replace or restore I!real or personal property to substantially the same condition it was in prior to being damaged during work ;performed in the course of incurring Clean-Up Costs or Corrective Action. However, such Restoration Costs shall not exceed the net present value of such property prior to incurring Clean-Up Costs or Corrective Action. Restoration Costs do not include costs associated with improvements or betterments. S. Storage Tank System means a stationary tank or tanks owned or operated by the Insured and shown in jltem 5 of the Declarations. Storage Tank System includes any on site integral piping or dispensing equipment, ancillary equipment and containment system associated with the tanks. T. Tank Fund means any state storage tank trust fund, state administered insurance program, or restoration funding for.Storage Tank Systems whose owners qualify for reimbursement, or any self insurance fund established for the purpose of funding Clean-Up Costs or Corrective Action for Pollution Conditions ,from a Storage Tank System. IN WITNESS WHEREOF the Company has caused this Policy to be signed by its president and secretary and signed on the Declarations page by a duly authorized representative of the Company. tit4€4.4L, >it e iSil!,1111"10H Elizabeth M. Tuck, Secretary Joseph L.Boren, President 81106 (10'02) 11 CI1941 INSURED'S COPY i Ct1�l SHOPS Renewa� t Policy #1 , g m�51 A I G i Tank G ar _. Mail the form to: ' , JLJJJ..LR 4 RIG TankGuards"'Insurance p 501 Carr Road,R23-1 A, ragran I N.t Il`$,k NCI P to IRA.* 1 Wilmington,DE 19809 Tel: 800.514,7167 Fax: 302.761.5659 1 Name of Insurance Company To Which Application Is Made: (herein called the Company) THIS IS AN APPLICATION FORA CLAIMS-MADE POLICY. STORAGE TANK THIRD,PARTY LIABILITY CORRECTIVE AC TION ON AND CLEANUP POLICY NOTICE:PLEASE ANSWER ALL QUESTIONS.ATTACH ADDITIONAL SHEETS OF PAPER IF NECESSARY. THIS POLICY PROVIDES DEFENSE EXPENSES SEPARATE FROM THE LIMIT OF LIABILITY THAT APPLIES TO LOSS.CORRECTIVE ACTION AND CLEANUP COSTS.NOTE THAT AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE AMOUNT. 1, Named Insured: City of Renton 2. Insured's Address: loss 8nuth Grady . R WA 98055 Phone: 425-43(F—/6.5 Fax: 425-430—lbb.5 3. Please provide a survey plot for this(facility,if there are above-ground tanks. 4. List all claims made against you during the past five.years for cleanup,or response action,or bodily injuryor property damage, resulting from the release of regulated substances, hazardous waste or any other pollutants, from this location or otherl1Iocations owned or operated by you, into the environment. Provide a brief description of the claim(s) and its disposition.If none,so state. N ion p 5. At the. time of the signing of this application, do you know of any facts or circumstances expected to result in a claim or claims being asserted against your company for environmental hclea up or respo sich masonabe, or for bodily injury or property damage arising from the release of pollutants into the environment? No 6. Have you during the past five years had any reportable releases or spills of regulated substances, hazardous waste or • any other pollutants,as defined by applicable environmental statutes or regulations? 1 I , ( )Yes i! No If yes,please describe. ! 7. Have you•during the last five years been prosecuted,or are you currently being prosecuted,for contravention of any standard or law relating to the release or threatened release from the Iocation.of a regulated substance, hazardous waste or any otherpollutant?( )Yes (XA No If yes, please give details. I 8, Is there a history of leaks or releases at any of your facilities not stated above?( )Yes (Ka No If yes, please;describe. • 9. Were all;tanks new at installation?(X)Yes ( )No • If no, provide details regarding the date manufactured, and any upgrades or changes made to the tank since the date manufactured. 10. Have any repairs or upgrades (including relining) been performed within the past ten years for any tank ati• any location?i,(nlyes ( )No If yes,please describe the repairs or upgrades performed? I 1 11. Please provide a.copy of the Spill Prevention and Counter Control plan with regard to the aboveground storage t.or tanks if any exists.Have any inspections or maintenance procedures as required by the plan,not been j ---,performed? (. )Yes ( )No If yes, please explain. . N/A 12. Were any tanks ever removed or closed at any location?( )Yes (X)No If yes, provide specific details as to why this occurred. li • 11 74693 (12/99i) i • 13. If aboveground tanks are present, please describe the security measures at the site to protect against theft and vandalism!I N/A , it 14. STORAGE TANK&LOCATION SCHEDULE:Copy and attach additional sheets If necessary. Facility I.D.# Facility Name P/B/pW 3555 NE 2nd St/ Maintenance Shops . Facility Address Facility Type Ii i Do you(Circle one Own)Operate 'Lease this facility? If not owned, please name the owner. STORAGE TANK&LOCATION SCHEDULE (Complete schedule with symbols below) ' 1 2 3 4 , : '5 Tank# 01, 02 Underground(UST)/Aboveground(AST) UST UST ' , Install Date Year 1985 1985 Capacity(Gallons) 12,000 12 ,000 Contents D B • Tank Construction Material F. F . Overfill/Spill Protection M M 1 Leak Detection S T $TD�T AST Diking&Base Construction Piping Construction Material F F Piping Leak Detection, K K • i Contents Tank Construction Overfill/Spill Protection AST Diking&Base Construction B.Unleaded Gasoline C.Steel A.Ball Check Valve K.Concrete,Synthetic I 1 ' C.Gasohol 1 E.Fiberglass M.Spill Containment Bucket Material,clays D.,F.,G.,H.Diesel F.FRP Clad Steel N.Flow Shut-off S.Other EPNDEP K.Kerosene X.Concrete O.Tight Fill ' approved seconda L Waste Oil!Used Oil ' . Y.Polyethylene ' P.Level Gauges, containment system M.Fuel 011 Z Other EPA/DEP Approved High Level Alarms Z.Dirt/Earth P.Generic Gasoline ' G.Cathodic Protection Q.Other EPNDEP Approved I ; , Q.Pesticide Sacrificial Anode Protection Method R.Ammonia compound; H.Cathodic Protection- Pipina Construction Material l' S.Chlorine compound , Impressed Current • B.Steel , I T.Haz.Substance(CERCLA) I.Double Walied(DW)- Tank Leak Detection C.Fiberglass , U.Mineral Acids Single Material N,Groundwater Monitoring F.,M.Double walled , V.Grades 5&6 bunker'C'oils R.Double Walled(DW)- Wells N.Approved Synthetic Material; ' W.Petroleum-base additive Dual Material E,Interstitial Monitoring Z.Other EPNDEP Approved X.Misc.petroleum-base . J.(DW)Synthetic Liner in 0.Vapor Monitoring Wells Piping Material Z.Other,Identify 11 Tank Construction Q.Visual Inspections of D.External Protective Coating V.(DW)Pipeless.UST with AST Systems E.C/P with sacrificial anode or Secondary Containment • Z.Other EPA/DEP Approved impressed current ii B.Internal Lining D.SPCC Plan-AST j ST1.S71-P3 F.Interstitial Space- Piping Leak Detection Double Walled Tank G.Electronic Line Leak Detector ' M.Manual Tank Gauging-UST with Flow Shutoff ; • S.Statistical Inventory J.interstitial Monitoring- Reconciliation(SIR)(USTs) Piping Filter 1 L.Automatic Tank Gauging B.External Monitoring ' . System(USTs) H.Mechanical Line • R.Interstitial Monitoring of AST Leak Detector Tank Bottom K.Interstitial Monitoring of T.Annual Tightness Test double wall piping with Inventory(USTs) V.Suction Pump Check Valve 74693 (12/99)' 2 of 4 . , I 15. Are there any tanks at this location(hat were not included in the Tank Schedule. If yes,please describe, ( )Yes fig)No III ,i , . , . 1, 1 16. Do you use an outside contractor or firm for compliance management services?This includes, but is not limited to,equipment inspection and monitoring,proper state and local regulatory paperwork completion,and filing, pooling gauges and monthly monitoring reports for you? Yes ( )No • if yes.please give the name and phone#of the firm you use. _:No r-t'hu)eA .,T D E._f_..Etw Po t -. S AL.eS, 1 Vic.-. 14,5 1•t-1:1 q to a a 17. Do you use la remote monitoring system,with an outside vendor who receives an alarm when a release occurs and is responsible for notifying the appropriate parties?( )Yes (X No if yes, please give the name of that vendor. 18. Do any plans exist to remove or replace any tanks within the next year?( )Yes (Xli No If yes, list when and why the removal or replacement is to occur. I 19. Do you currently have pollution liability insurance coverage for the tanks applied for on this application? IR)Yes ( )No If so, please list below the name of the carrier, expiring premium,expiring deductible,retroactive date and limits of liability;or attach a copy of your current policy declarations page.,, commerce&Industry Policy#: 1'7 g(o y 5., , Expiration Date: 1/ 1/D 5 LIMITS DESIRED: (each incident/aggregate) ( )$500,000/$1 million ().;)$1 million/$1 million ( )$1 million/$2 million (iii million/$2 million ( OTHER: D CTIBLE DESIRED: (each incident) ( )$5,00I 0 ( �A$10,000 )$100,000 � ( )$25,000 ( )$50,000 { )$250,000 ( )OTHER: For Deductibles;25,000 or above,please include your most current audited financial statement. THIS APPLICATION DOES NOT BIND THE APPLICANT TO BUY, OR THE COMPANY TO ISSUE THE INSURANCE, BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED, AND IT WILL BE ATTACHED TO AND MADE A PART OF THE POLICY.THE UNDERSIGNED APPLICANT DECLARES THAT THE STATEMENTS SET FORTH IN THIS APPLICATION ARE TRUE AND THAT NO MATERIAL FACTS HAVE BEEN SUPPRESSED OR MISSTATED. THE APPLICANT FURTHER DECLARES THAT IF THE INFORMATION SUPPLIED ON THIS APPLICATION CHANGES BETWEEN THE DATE OF THIS APPLICATION AND THE TIME WHEN THE POLICY IS ISSUED,THE APPLICANT WILL IMMEDIATELY NOTIFY THE COMPANY OF SUCH CHANGES, AND THE COMPANY MAY WITHDRAW OR MODIFY ANY OUTSTANDING QUOTATIONS AND/OR AUTHORIZATION OR AGREEMENT TO BIND THE INSURANCE. ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE COMPANY IN CONJUNCTION WITH THIS APPLICATION ARE HEREBY 1NCORPORATfcD Y REFERENCE IN O,THIS APPLICATION AND MADE A PART HEREOF. ' APPLICANT- (s ature); — BROKER: Arthur .T Gallagher—Denver (Firm) ; , APPLICANT:'*OF r e ms' 7900 East Union Ave . #200 I DATE: /e7 _ (Address) Denver, CO 80237 (Contact person&telephone#) I I Signature of broker or agent) II) I (License number and state) I (Tax I.D.#) 1 74693(12199) - 3 of 4 NOTE:IN•SOME STATES.ANY PERSON WF:""'. .TINGLY AND WITH INTENT TO DEFRAUD P'.".+N;,..ANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE. INTAINING ANY MATERIALLY FALSE INFORMA .,,'I, OR CONCEALS, FOR THE PURPOSE OF MISLEADING,INFORMATION CONCERNING ANY FACT MATERIAL THERETO,COMMITS A FRAUDULENT INSURANCE ACT,WHICH IS ACRIME. IF :N CE TO ARKANSAS APPLICANTS: "ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A d R BENEFIT,OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY JECTTO FINES AND CONFINEMENT IN PRISON" ' I NOTICE TO COLORADO APPLICANTS: "IT IS UNLAWFUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMATION TO,AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE COMPANY,PENALTIES MAY INCLUDE IMPRISONMENT, FINES, DENIAL'OF INSURANCE, AND CIVIL DAMAGES. ANY INSURANCE COMPANY OR AGENT OF AN INSURANCE COMPANY WHO KNOWINGLY PROVIDES FALSE,INCOMPLETE,OR MISLEADING FACTS OR INFORMATION TO A POLICYHOLDER OR CLAIMANT FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE POLICYHOLDER OR CLAIMANT WITH REGARD TO A SETTLEMENT OR AWARD PAYABLE FROM INSURANCE PROCEEDS SHALL BE REPORTED TO THE COLORADO DIVISION OF INSURANCE WITHIN THE DEPARTMENT OF REGULATORY AGENCIES." NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: "WARNING: IT IS A CRIME TO PROVIDE FALSE OR MISLEADING INFORMATION TO AN INSURER FOR THE PURPOSE OF DEFRAUDING THE INSURER OR ANY OTHER PERSON.PENALTIES INCLUDE IMPRISONMENT AND/OR FINES. IN ADDITIONS.AN INSURER MAY DENY INSURANCE BENEFITS IF FALSE INFORMATION MATERIALLY RELATED TO A CLAIM WAS PROVIDED BY THE APPLICANT.", NOTICE TO FLORIDA APPLICANTS: "ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY IN THE THIRD DEGREE." NOTICE TO KENTUCKY APPLICANTS: "ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING,INFORMATION CONCERNING ANY FACT MATERIAL THERETO,COMMITS A FRAUDULENT INSURANCE ACT.WHICH IS A CRIME." NOTICE TO LOUISIANA APPLICANTS: "ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON," II NOTICE TO MAINE APPLICANTS: "IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY,PENALTIES MAY INCLUDE IMPRISONMENT,FINES OR A DENIAL OF INSURANCE BENEFITS." I 1 N TO MINNESOTA APPLICANTS: "ANY PERSON WHO SUBMITS AN APPLICATION OR FILES A CLAIM WITH INTENT TO DEFRAUD OR H1111OMMIT A,FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME." NOTICE TO NEW JERSEY APPLICANTS:"ANY PERSON WHO INCLUDES ANY FALSE OR MISLEADING INFORMATION ON AN APPLICATION FOR AN INSURANCE POLICY IS SUBJECT TO CRIMINAL AND CIVIL PENALTIES." I NOTICE TO NEW INEXICO APPLICANTS:'ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES. I NOTICE TO NEW YORK APPLICANTS: `ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES'AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A;FRAUDULENT INSURANCE ACT.WHICH IS A CRIME AND SHALL ALSO BE SUBJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS AND •THE STATED VALUE OF THE CLAIM FOR EACH SUCH VIOLATION.' NOTICE TO OHIO APPLICANTS:"ANY PERSON WHO,WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.` • NOTICE TO OKLAHOMA APPLICANTS:"WARNING:ANY.PERSON WHO KNOWINGLY,AND WITH INTENT TO INJURE.DEFRAUD OR.DECEIVE ANY INSURER, MAKES ANY CLAIM FOR THE PROCEEDS OF AN INSURANCE POLICY CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY"(365:15-1-10,36§3613.1). NOTICE TO PENNSYLVANIA APPLICANTS: "ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A'FRAUDULENT INSURANCE ACT,WHICH IS A CRIME AND SUBJECTS SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES." I NOTICE TO VIRGINIA APPLICANTS:."IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN _ INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES INCLUDE IMPRISONMENT, FINES AND DENIAL OF INSURANCE BENEFITS.' 0 Se mpleted AOpIIcatlon To: AIG TankGuard$M Insurance Program I 501 Carr Road,R23-1A Wilmington,DE 19809 • Or you may also FAX application to 1.302.761.5659 If you have any questions you can reach a customer service representative at 1.800.514.7167 from Sam to 5pm Eastern Time. 74693(12/99) II 4 of 4 • ' j- .k.011. 11( 1 :_f_ 11 p Date: t / D '1 Site Name: t_,(-r'/ to r I . Tnmo 1i, • Technician: 3 ("J't bete- Job Number: 4'O 6/ 762 Arrival Time: 2'00 Initials Travel.Time to Site: !, �'" t Departure lime: 7/ -/-5-- Initials Thank you for the opportunity to perform your Annual Compliance Testing and/or provide maintenance at your site. Compliance Testing: For your privacy,we do not leave your results or site data on site. We prefer to mail all official documents directly to you as to make certain that the test data is delivered to the appropriate person/station owner. You will receive an invoice from our office for the services performed at your site. Once we receive your payment,we will promptly forward your test data to you to sign and forward to the appropriate reporting agency. i All work is complete! O We have tested your site,per the proposed scope of work. Before your fuel system can be certified,repairs need to be made. If an authorized signer is available and we have the parts necessary for repair in our truck stock,we will make the repairs and retest. It is our goal to bring your site into compliance the same day. If an authorized signer is not available and the repairs are costly, we will provide the owner with a written proposal before repairs are made. Our accounting department will forward you an invoice for the scope of work completed on site. • I The following scope of irro was performed on site... fit Y J& S X Z. (0 t.)(-6-e- A C.A3t Di Es 1 -y..,lk. VtilbAa`met (.. .-)<_iF,Cv= 7d0eJ • Necessary repairs made while the technician was on site... O O ,The following parts and repairs are needed to bring your site into compliance. We were unable to test your site for the following reasons: ❑ Improper fuel level(please note this is a minimum$200.00 fee per our contract) 0 Repairs suggested to ensure quality service and safety: /Z&r i 0 V e 7 9-a 2-vrtR 1)1l r 7 ,0e. " ❑ Additional comments or notes to the office: If you have any questions regarding procedures,'your invoice, repairs or test findings, please do not hesitate to call 800-742-9620. We have licensed technicians who would be happy to answer any of your questions. All compliance test data be forwarded to the site owner upon receipt of full payment. Thank you for your business. We look forward to "nuing cur. hip with you. 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',, i'.,..,:oe'.-..."--.;.",:''',..•., ..1::;',. ./,,r-....:^..'f''' ."..... •-- ' . . . , . • ..,...'.:11 • . • , .: - ---.-. ...,...-===-Narr"--.. ... ....,,,,.... ...SNOr."----, ..--,'..t.j.'..,-,"1,5‘:".,,V,:- .1..•.70,.':,-: '.-•.::Ari-...-i'-'!....1":,:-.r..",,!'s,t4,r,)... 1 . .1 Ill • In cc. .. < c, a a • 0 csi _„ 0 - 2. • z .., . 0 1 • - o < to 1 • • . 0., _, . rn I t •c 3 ;II . • b„4 i • ...Abs. 1-,— . . < E iS 0 u_ • INI I . E . . = o 1141h. 0 ril I r4 ge i I . I . 1a 41 0 0 co ' . r.-.. . . . • City of Renton Received Arthur J. Gallagher Risk Management Services, Inc. �-�i� Or RENTON FEB 01 2008 FEB 0 4 2008 Human Resources & Risk Management RECENED January 25, 2008 CITY CLERK'S OFPJCE Ms. Pauletta Sulky City of Renton 1055 South Grady Way Renton, WA 98055 RE: Storage Tank Liability Policy#007786457 Policy Period: January 1, 2008 to January 1, 2009 Dear Paulie: Enclosed is the renewal of the Storage Tank Liability Policy through Commerce & Industry Insurance Company for City of Renton effective January 1, 2008. We have reviewed this policy for accuracy and find it to be correct as it was issued. Please review and let us know if you have any questions. Thank you! Sincerely, Arthur J. Gallagher Risk Management Services, Inc.C_ *atei/e/ a,Vierra, CISR Account Manager JV/j Enclosure 6399 South Fiddler's Green Circle,Suite 200 Greenwood Village,CO 80111-4949 303.773.9999 Fax 303.773.9776 Toll Free 800.333.3231 www.ajg.com 11 COMMERCE AND INDUSTRY INSURANCE COMPANY (Executive Offices) (Administrative Offices) 70 PINE STREET 175 WATER STREETIII I I NEW YORK'III ,N.Y. 10270 NEW YORK,N.Y. 10038 A Capital Stock Company I (herein called the"Company") 1 AIG Environmental® 1 STORAGE TANK THIRD-PARTY LIABILITY,CORRECTIVE ACTION AND CLEANUP COSTS POLICY DECLARATIONS II THIS IS A CLAIMS-MADE AND REPORTED POLICY. PLEASE READ CAREFULLY. I ! POLICY NUMBER: 007786457 Cityof Renton Item 1. NAMED INSURED: ADDRESS: 1055 South Grady Way Renton, WA 98055 01/01/08 01/01/09 Item 2. POLICY PERIOD: FROM TO 12:01 AM Standard Time at the Address of the Named Insured shown above Item 3. LIMIT OF LIABILITY: $ 2, 0 0 0, 0 0 0 EACH INCIDENT LIMIT $ 2, 000, 000 AGGREGATE LIMIT Item 4. DEDUCTIBLE: $ i 5, 000 EACH INCIDENT Item 5. COVERED STORAGE TANK SYSTEM(S): See Storage Tank Schedule Item 6. RETROACTIVE DATE: See Storage Tank Schedule Item 7. POLICY PREMIUM: $2, 524. 00 Premium for Certified Acts of Terrorism Coverage Under TRIA 2002: II $146.9,0 Included in Policy Premium r, II II i ! Item 8. FORMS,ENDORSEMENTS AND SCHEDULES ATTACHED TO THIS POLICY: See Attached Form Schedule BROKER 'Chamber Insurance Agency Services !!" _.--k5L- filf., By II AUTHORIZED REPRES ENTATIVE II or countersignature(in states where applicable)' 11 I Copyright,American International Group,Inc,2002 Page 1 of 1 III 81206(11102) I I CI1948 II 1 CIT0010 11 III • POLICYHOLDER NOTICE Thank you for purchasing insurance from a member company of American International Group, Inc. (MG). The MG member companies generally pay compensation to brokers and independent agents, and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by MG member companies to brokers and independent agents in the United States by visiting our website at www.aigproducercompensation.com or by calling MG at 1-800- 706-3102. • 111 91222(07/06) AMERICAN INTERNATIONAL COMPANIES® • MG ENVIRONMENTAL® STORAGE TANK THIRD-PARTY LIABILITY, CORRECTIVE ACTION AND CLEAN-UP COSTS POLICY NOTICE: THIS IS A CLAIMS-MADE-ANDREPORTED POUCY. PLEASE READ CAREFULLY. ADDITIONALLY, THIS POLICY HAS CERTAIN•PROVISIONS AND REQUIREMENTS UNIQUE TO IT AND MAY BE DIFFERENT FROM OTHER POLICIES THE INSURED MAY HAVE PURCHASED. DEFINED TERMS, OTHER•THAN HEADINGS,APPEAR IN BOLD FACE TYPE. THE DESCRIPTIONS IN ANY HEADINGS OR SUB-HEADINGS OF THIS POUCY ARE INSERTED SOLELY FOR CONVENIENCE AND DO NOT CONSTITUTE ANY PART OF THE TERMS OR CONDITIONS HEREOF. In consideration of the payment of the premium, in reliance upon the statements in the Declarations anti the Application,annexed hereto and made a part of this Policy or,if not annexed hereto,which are deemed to be annexed hereto and made a part of this Policy, and pursuant to all of the terms of this Policy, the Company agrees with the Named insured as follows: I. INSURING AGREEMENT 1. COVERAGES: COVERAGE A—THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE DUE TO A STORAGE TANK RELEASE To pay on behalf of the Insured, Loss that the Insured becomes legally obligated to pay as a result of Claims for Bodily Injury or Property Damage resulting from Pollution Conditions from a covered Storage Tank System, provided such Claims are first made against the Insured and reported to the Company in writing during the Policy Period or during the Extended Reporting-Period, if applicable.The Pollution Condition must commence on or after the Retroactive Date as shown in Item 6 of the Declarations. COVERAGE B-CLEAN-UP COSTS OR CORRECTIVE ACTION DUE TO A STORAGE TANK RELEASE To pay on behalf of the Insured, Clean-Up Costs or Corrective Action that the Insured becomes legally obligated to pay as a result of a Confirmed Release from a covered Storage Tank System, provided such • Confirmed Release is first reported to the Company in writing during the Policy Period or during the . Extended Reporting Period, if applicable. The Pollution Condition must commence on or after the Retroactive Date as shown in Item 6 of the Declarations. 2. DEFENSE: The Company shall have the right and duty to defend any Claims covered under Coverage A or any civil or administrative proceedings or suits which seek to impose a legal obligation upon the Insured to undertake Clean-Up Costs.or Corrective Action for a Confirmed Release to which Coverage B applies. The Company's duty to defend or continue defending any such Claims,civil or administrative proceedings or suits ant to pay. any Loss, Corrective Action, Clean-Up Costs or defense costs, charges and expenses, shall cease once the applicable limit of liability, as described in Section V. LIMITS OF LIABILITY AND DEDUCTIBLE,has been exhausted. 3. _INDEPENDENT COUNSEL:i • In the event the Insured is entitled by law to select Independent counsel to defend the Insured at the Company's expense, the attorney fees and aII other litigation expenses the Company must pay to that counsel are limited to 81106(10/05) Ci2766 I the rates the Company would actually pay to counsel that the Company retains in the ord inary Y course of business in the defense of similar Claims in the community where the Claim arose or Is being defended. Additionally, the Company may exercise the right to require that such counsel have certain minimum qualifications with respect to their competency,including experience in defending Claims similar to the one pending against the Insured, and to require such counsel to have errors and omissions insurance coverage. As respects any such counsel, the Insured agrees that counsel will timely respond to the Company's request for information regarding the Claim.The Insured may at any time,by its signed consent,freely and fully waive its right to select independent counsel. 4. 'SETTLEMENT: The Company will present any settlement offers to the Insured, and if the Insured refuses to consent to any settlement within the limits of liability of this Policy recommended by the Company and acceptable to the claimant, the Company's duty to defend the Insured shall then cease and the Insured shall thereafter negotiate or defend such Claim independently of the Company and the Company's liability shall not exceed the amount, less the Deductible or any outstanding Deductible balance, for which the Claim could have been settled if such recommendation was consented to. II. EXCLUSIONS 1. COMMON EXCLUSIONS-APPLICABLE TO ALL COVERAGES: This Policy does not apply to,Claims,Clean-Up Costs or Corrective Action,or Loss: A. CRIMINAL FINES,PENALTIES,AND ASSESSMENTS: Due to any criminal fines,criminal penalties or criminal assessments. 13. CONTRACTUAL LIABILITY: Arising from liability of others assumed by the Insured under any contract or agreement,unless the liability of the Insured would have attached in the absence of such contract or agreement or the contract or agreement is an Insured Contract. C. INTENTIONAL NONCOMPLIANCE: Arising from Pollution Conditions based upon or attributable to any Responsible Insured's intentional, willful or deliberate noncompliance with any statute, regulation including those set forth in Tide 40 of the Code of Federal Regulations, ordinance, administrative complaint, notice of violation, notice letter, executive order,or instruction of any governmental agency or body. D. INTERNAL EXPENSES: For costs, charges or expenses incurred by the Insured for goods supplied or services performed by the staff or salaried employees of the Insured,or its parent,subsidiary or affiliate,except if in response to an emergency or pursuant to Environmental Laws that require immediate remediation of Pollution Conditions, or unless such costs,charges or expenses are incurred with the prior written approval of the Company in its sole discretion. 81106 (10(05) CI2766 2 E. INSURED vs. INSURED: Arising from a Claim brought by any Insured against any other person or entity who is also an Insured under this Policy. This exclusion does not apply to Claims initiated by third parties'or Claims that arise out of an indemnification given by one Named Insured to another Named Insured in an Insured Contract. F. EMPLOYER LIABILITY:' Arising from Bodily Injury to an Insured or its parent, subsidiary or affiliate arising out of and in the course of employment by the Insured or its parent, subsidiary or affiliate. This exclusion applies whether the Insured may be liable as an employer or in any other capacity and to any obligation to share damages with or'repay third parties who must pay damages because of the injury. G. PRIOR KNOWLEDGE/NON-DISCLOSURE: lArising from Pollution Conditions existing prior to the Inception Date and known by a Responsible Insured and not disclosed in the application for this Policy, or any previous policy for which this 'Policy is a renewal thereof. H. COST TO CONFIRM A RELEASE FROM A STORAGE TANK SYSTEM: 'For any costs, charges or expenses incurred to investigate or certify that a Confirmed Release has taken place. I. COST TO REPAIR, REPLACE OR UPGRADE A STORAGE TANK SYSTEM: For any costs arisingout of the reconstruction, repair, replacement, upgrading p p or rebuilding,of any Storage Tank System or for any other improvements, site enhancements or routine maintenance on, within or under the site at which Storage Tank Systems are located. J. DIVESTED STORAGE TANK SYSTEMS OR SITES: Arising from Pollution; Conditions or Confirmed Releases which commence after the date that a covered Storage Tank System, or the site at which the Storage Tank System is located, is sold, given away, abandoned, or subleased, unless the sublease has been approved in writing by the underwriter prior to th'e commencement of the sublease. K. STORAGE TANK SYSTEM CONTENTS: 1. Arising from physical injury, including but not limited to contamination, of the contents of a Storage Tank System; or 2. Arising out of Property Damage due to physical injury, including but not limited to contamination, of the contents of a Storage Tank System; or 3. For any costs arising out of the removing, replacing or recycling of the contents of, any Storage Tank System. L. WAR Arising directly or indirectly as a result of or in connection with war, whether declared or not, or any act or condition incident to war. War includes civil war, insurrection, act of foreign enemy, civil commotion, factional civil commotion, military or usurped power, rebellion or revolution. 11, 81106(10/05) C12766 3 III. NOTICE,REQUIREMENTS AND CLAIM PROVISIONS The Insured shall provide the Company with notice of Confirmed Release, Claim and Pollution Conditions, as follows:' 1. In the event of a Confirmed Release, Claim or Pollution Condition, the Insured shall give written notice to: Manager, Pollution Insurance Products Unit AIG Technical Services, Inc. Environmental Claims Department 101 Hudson St. - 31" Floor Jersey City, NJ 07302 Fax: 201-631-5051 or other address(es) as substituted by the Company in writing. 2. The Insured shall give written notice of Claims, a Confirmed Release or Pollution Conditions as soon as possible, but in any event during the Policy Period or during the Extended Reporting Period, if applicable. Notice under all coverages shall include, at a minimum, information sufficient to identify the Named Insured, the Storage Tank System, the names of persons with knowledge of the Pollution Conditions and all known and reasonably obtainable information regarding the time, place, cause, nature of and other circumstances of the Pollution Conditions. The Insured shall forward the following to the Company as soon as possible: (a) All reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the claimant(s) and available witnesses; (b) All correspondence between the Insured and any third party Claimant, including but not limited to any Implementing Agency; and all demands, summonses, notices or other process or papers filed with a court of law, administrative agency, Implementing Agency or an investigative body; and I(c) Other information in the possession of the Insured or its hired experts which the Company reasonably deems necessary. IV. RIGHTS OF THE COMPANY AND DUTIES OF THE INSURED IN THE EVENT OF POLLUTION CONDITIONS A. The Company's Rights 1 The Company shall have the right but not the duty to clean up or mitigate Pollution Conditions upon receiving notice as provided in Section III. of this Policy. Any sums expended in taking such action by the Company will be deemed incurred or expended by the Insured and shall be applied against the limits of liability and deductible under this Policy. B. Duties of the Insured "'The' Named Insured•shall have the duty to clean up Pollution Conditions to the extent required by Environmental Laws, by retaining competent professional(s) or contractor(s) mutually acceptable to the Company and the Named Insured. The Company shall have the right but not the duty to review and I approve all aspects of any such clean-up. The Named Insured shall notify the Company of actions and measures taken pursuant to this Paragraph. 81 106'(10/05) C12766 4 i I V. LIMITS OF LIABILITY AND DEDUCTIBLE Regardless of the number of Claims, Claimants, Confirmed Releases, Pollution Conditions or Insureds under this Policy, the following limits of liability apply: A. 'Coverage A and B Aggregate The Company's total liability for all Loss covered under Coverage A and Clean-Up Costs and Corrective Action covered under Coverage B shall not exceed the "Aggregate Limit" stated in Item 3 of the Declarations. B. Each Incident Limit Subject to Paragraph V.A. above, the most the Company will pay for all Loss and Clean-Up Costs and Corrective Action arising from the same, related or continuous Pollution Conditions is the, "Each lIncident" limit of coverage stated in Item 3 of the Declarations. "Each Incident" as used within this Policy shall,mean each same, related or continuous Pollution Condition. C. Related Claims 1. If the Insured first reports a Claim, Confirmed Release or discovers Pollution Conditions during the Policy Period and reports them to the Company in accordance with Section III., all continuous or related Pollution Conditions reported to the Company under a subsequent policy issued by the Company or its affiliate providing substantially the same coverages as this Policy shall be deemed to have been first discovered and reported during this Policy Period and shall be subject to the same Limit of Liability.' 12. All Claims and reports of Confirmed Releases made during one or more policy periods issued by the Company or its affiliate providing substantially the same coverages, resulting in Loss, or Clean-Up Costs or Corrective Action, or in any combination thereof, and arising out of the same, or continuous or related Pollution Conditions, shall be considered one incident and will be subject to the same Limit of Liability. Such Claims or reports of Confirmed Releases shall be deemed first reported to the Company during the policy period in which the first such Claim or !report of Confirmed Release was reported to the Company or an affiliate and will be subject to the Limit of Liability applicable to that policy period. D. ,Deductible Subject to Paragraphs V. A.. and V. B. above, this Policy will pay Clean-Up Costs, Corrective Action or Loss in excess of the Deductible amount stated in Item 4 of the Declarations up to but not exceeding the applicable "Each Incident" limit of coverage. The'Insured shall promptly reimburse the Company for advancing any element of Clean-Up,Costs or iiCorrective Action or Loss falling within the Deductible. VI. CONDITIONS A. 'Assignment - This Policy may be assigned with the prior written consent of the Companysl which consent shall not be unreasonably withheld or delayed. Assignment of interest under this Policy shall not bind the Company until its consent is endorsed thereon. B. Subrogation - In the event of any payment under this Policy, the Company shall be subrogated to all the iInsured's rights of recovery therefor against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights 81106 (10/05) CI2766 5 including without limitation, assignment of the Insured's rights against any person or organization who caused Pollution Conditions on account of which the Company made any payment under this Policy. The Insured shall do nothing to prejudice the Company's rights under this Paragraph subsequent to Loss. Any', recovery as a result:of subrogation proceedings arising out of the payment of Loss,,Clean-Up Costs or Corrective Action covered under this Policy shall accrue first to the Insured to the extent of any payments in excess of the limit of coverage; then to the Company to the extent of its' payment sunder the Policy; and then to the Insured to the extent of its Deductible. Expenses incurred in such subrogation proceedings shall be apportioned among the interested parties in the recovery in the proportion that each interested party's share in the recovery bears to the total recovery. C. 'mCooperation - The Insured shall cooperate with the Company and offer all reasonable assistance in the investigation and defense of Claims under the applicable Coverages purchased. The Company may require that the Insured submit to examination under oath, and attend hearings, depositions and trials. In the'course of investigation or defense, the Company may require written statements or the! Insured's attendance at meetings with the Company. The Insured must assist the Company in i effecting settlement, securing and providing evidence and obtaining the attendance of witnesses. D. liChanges - Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this Policy or estop the Company from asserting any rights under the terms of this Policy; nor shall the terms of this Policy be waived or changed, except by II endorsement issued by the Company to form a part of this Policy. E. Voluntary Payments - No Insured shall voluntarily enter into any settlement, or make any payment or assume any obligation unless in response to an emergency or pursuant to Environmental Laws that require immediate remediation of Pollution Conditions, without the Company's consent which shall not be unreasonably withheld, except at the Insured's own cost. F. Concealment or Fraud - This entire Policy shall be void if, whether before or after Clean-Up Costs or Corrective Action are incurred or a Claim is first made, the Named Insured has willfully concealed or misrepresented any fact or circumstance material to the granting of coverage under this Policy, including but not limited to, the description of the Storage Tank System, or the interest of the Insured 1 therein. G. Cancellation - This Policy may be cancelled by the Named Insured by surrender thereof to the Company or any of its authorized agents or by mailing to the Company written notice stating when thereafter the cancellation shall be effective. This Policy may be cancelled by the Company only for the reasons stated below by mailing to the Named Insured at the address shown in the Policy, written notice stating when, not less than 60 days (10 days for nonpayment of premium or material misrepresentation by the Insured), thereafter such cancellation shall be effective. Proof of mailing of such notice shall be sufficient U proof of notice. ' 1. Material misrepresentation by the Insured; 2. The Insured's failure to comply with the material terms, conditions or contractual obligations under this Policy, including failure to pay any premium when due; 3. A change in operation's at a facility containing a Storage Tank System during the Policy Period that materially increases a risk covered under this Policy. I The time of surrender or the effective date and hour of cancellation stated in the notice shall become the end of the Policy Period. Delivery of such written notice either by the Named Insured or by the Company shall be equivalent to mailing. If the Named Insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the Company cancels, earned premium 81106 (10/05) CI2766 6 shall be computed pro-rata., Premium adjustment may be either at the time cancellation is effected or as 'Soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. H. !Other Insurance - If other valid and collectible insurance or funds from any Tank Fund are available to the Insured for Loss, Clean-Up Costs or Corrective Action covered by this Policy, the Insured shall promptly, upon the request of the Company, provide the Company with copies of all such policies or fund documentation. The Company's obligations are limited as follows: 1. Except as set forth in subparagraph 3. of this Paragraph, this insurance is primary, and the Company's obligations are not affected unless any of the other insurance is also primary. In that case, the Company will share with all such other insurance by the method described in Paragraph 2. below. 2. If all of the other insurance permits contribution by equal shares, the Company will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any'of the other insurance does not permit contribution by equal shares, the Company will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of II insurance to the total applicable limits of insurance of all insurers. 3. This insurance shall apply as excess insurance over any Tank Fund, provided that in the event of the receivership, insolvency, or inability to pay of any state fund or program, this insurance shall act as primary insurance. Where this insurance is excess, the Company will pay only its share of the amount of Loss, Clean-Up Costs or Corrective Action, if any, that exceeds the total amount available through the Tank Fund. I. Right of Access and Inspection — To the extent the Insured has such rights, any of the Company's authorized representatives shall have the right and opportunity but not the obligation to interview persons employed by the Insured and to inspect at any reasonable time, during the Policy Period or Sf.thereafter, the Storage Tank System or the site at which the Storage Tank System is located. Neither the Company nor its representatives shall assume any responsibility or duty to the Insured or to any !other party, person or entity, by reason of such right or inspection. Neither the Company's right to (make inspections, sample and monitor, nor the actual undertaking thereof nor any report thereon shall constitute an undertaking 'on behalf of the Insured or others, to determine or warrant that property or operations are safe, healthful or conform to acceptable engineering practices or are in compliance with any law, rule or regulation. The Named Insured agrees to provide appropriate personnel to assist the Company's representatives during any inspection. J. Access to Information - The Named Insured agrees to provide the Company with access to any information developed or 'discovered by the Insured concerning Loss, Clean-Up Costs or Corrective Action, or Pollution Conditions covered under this Policy, whether or not deemed by the Insured to be relevant to such Loss, Clean-Up Costs or Corrective Action, or Pollution Conditions and to provide the Company access to interview any Insured and review any documents of the Insured. K. Representations - By acceptance of this Policy, the Named Insured agrees that the statements in the Declarations, the Application and, if applicable, the Report/Worksheet are their warranties, agreements and representations, that this Policy is issued in reliance upon the truth of such ('warranties, agreements and representations and that this Policy embodies all agreements existing between the Insured and the Company or any of its agents relating to this insurance. L. I'iAction Against Company r No third-party action shall lie against the Company, unless as a ';condition "precedent thereto there shall have been full compliance with all of the terms of this Policy,; nor until the amount of the Insured's obligation to pay shall have been finally determined either by judgment I 81106110/05) ' CI2766 7 against the Insured after actual trial or by written agreement of the Insured, the claimant and the Company. Any person or organization,or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this Policy to the extent of the insurance afforded by the Policy. No person or organization shall have any right under this Policy to join the Company as a party to any action against the Insured to determine the Insured's liability, nor shall the Company be impleaded by the Insured or his legal representative. Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company of any of its obligations hereunder. M. Arbitration - It is hereby understood and agreed that all disputes or differences that may arise under or in connection with this Policy, whether arising before or after termination of this Policy,'including any determination of the amount of Loss, may be submitted to the American Arbitration Association ("AAA") under and in accordance with the United States Arbitration Act (9 U.S.C.) and'the then prevailing commercial arbitration rules of the AAA. The arbitrators shall be chosen in the manner and within the time frames provided by such rules. If permitted under such rules, the arbitrators shall be three disinterested individuals having knowledge of the legal, corporate management, or insurance issues relevant to the matters in dispute. Any party may commence such arbitration proceeding and the arbitration shall be conducted in the Insured's state of domicile. The arbitrators shall give due consideration to the general principles of the law of the Insured's state of domicile in the construction and interpretation of the provisions of this Policy; provided, however, that the terms, conditions, provisions and exclusions of this Policy, are to lbe construed in an evenhanded fashion as between the parties. Where the language of this Policy is alleged to be ambiguous or otherwise unclear, the issue shall be resolved in the manner most consistent with the relevant terms, conditions, provisions or exclusions of the Policy (without regard to the authorship of the language, the doctrine of reasonable expectation of the parties and without any presumption or arbitrary interpretation or construction in favor of either party or parties, and in accordance with the intent of the parties). iThe'written decision of the arbitrators shall set forth its reasoning, shall be provided simultaneously to both parties and shall be binding on them. The arbitrators' award shall not include attorney fees or other costs. Judgment on the award may be entered in any court of competent jurisdiction. Each party shall bear equally the expenses of the arbitration. N. Choice of Law - In the event that the Insured and the Company dispute the validity or formation of this Policy or the meaning, interpretation or operation of any term, condition, definition or provision of 'this Policy resulting in litigation, arbitration or other form of dispute resolution, the Insured and the Company agree that the law of the State of New York shall apply. O. Acknowledgment of Shared Limits - By acceptance of this Policy, the Named Insureds understand, agree and acknowledge that the Policy contains an Aggregate Limit that is applicable to, and will be shared by, all Named Insureds and all other Insureds who are or may become insured hereunder. In view of the operation and nature of this shared Aggregate Limit, the Named Insureds and all other Insureds understand and agree that prior to filing a Claim or reporting a Confirmed Release under the Policy, the Aggregate Limit may be exhausted or reduced by prior payments for other Claims, Clean- Up Costs or Corrective Action under the Policy. 811061(10/05) CI2766 a VII. EXTENDED REPORTING PERIOD FOR CLAIMS The Named Insured shall be entitled to an Automatic Extended Reporting Period, and (with certain exceptions as described in Paragraph B. of this Section) be entitled to purchase an Optional Extended Reporting Period for ,any Coverages terminated, upon termination of coverage as defined in Paragraph B.3. of this Section. Neither the Automatic nor the Optional Extended Reporting Period shall reinstate or increase any of the Limits of Liability of this Policy. A. Automatic Extended Reporting Period Provided that the Named Insured has not purchased any other insurance to replace this insuranbe�and which applies to a Claim or a Confirmed Release otherwise covered hereunder, the Named Insured shall have the right to the following: a period of six (6) months following the effective date, of such termination of coverage in which to provide written notice to the Company of a Claim first made during the Policy Period or Automatic Extended Reporting Period and first reported within the Automatic Extended Reporting Period, or Confirmed Release first reported within the Automatic Extended Reporting Period. A Claim first made during the Policy Period or Automatic Extended Reporting Period and first reported within the Automatic Extended Reporting Period, or Confirmed Release first reported within the Automatic Extended Reporting Period will be deemed to have been made on the last day of the Policy Period, provided that the Claim or Confirmed Release arises from Pollution Conditions that commenced before the end of the Policy Period and is otherwise covered by this Policy. No part of the Automatic Extended Reporting Period shall apply if the Optional Extended Reporting Period is purchased. B. Optional Extended Reporting Period The Named Insured shall be entitled to purchase an Optional Extended Reporting Period upon termination of coverage as defined herein (except in the event of nonpayment of premium), as follows: 1. A Claim first made during the Policy Period or during the Optional Extended Reporting Period and first reported during the Optional Extended Reporting Period, or a Confirmed Release first reported within III the Optional Extended,Reporting Period, if purchased in accordance with the provisions contained in Paragraph 2. below, will be deemed to have been made on the last day of the Policy Period, provided that the Claim or Confirmed Release arises from Pollution Conditions that commenced before the end of the Policy Period and is otherwise covered by this Policy. 2. The Company shall issue an endorsement providing an Optional Extended Reporting Period of up to forty (40) months from termination of coverage hereunder for all Storage Tank Systems, or for a Storage Tank System located at a specific facility, provided that the Named Insured: (a) makes a written request for such endorsement which the Company receives within sixty (60) days after termination of coverage as defined herein; and 11 (b) pays when due an amount equal to the premium for the Optional Extended Reporting Period plus any premium' for the Policy Period which is owed and has not yet been paid. If these premiums are paid when due, the Extended Reporting Period may not be cancelled, provided that all other terms and conditions of the Policy are met. 3. Termination of coverage occurs: (a) at the end of the Policy Period, or I I i 81106 (10/05) CI2766 9 (b) at the time the Policy or renewal policy becomes effective with a decrease in the limit of liability, a reduction of coverage, an increased deductible or self-insured retention, new exclusion or any other change in coverage less favorable to the Insured. 4. The Optional Extended Reporting Period is available to the Named Insured for not more than 100% of the policy premium of this Policy. VIII. DEFINITIONS A. Bodily Injury means physical injury, or sickness, disease, mental anguish or emotional) distress sustained by any person including death resulting therefrom. 'B. Claim means a written demand received by an Insured seeking a remedy and alleging liability or responsibility on the part of the Insured for Loss. C. Clean-Up Costs means: Reasonable and necessary expenses for the investigation, removal or remediation of Pollution Conditions including associated monitoring, or disposal of soil, surfacewater, groundwater or other contamination: (a) To the extent required by Environmental Laws; or (b) That have been actually incurred by the government or any political subdivision of the United States of America or any state thereof or Canada or any province thereof, or by third parties. Clean-Up Costs also include Restoration Costs. ID. Confirmed Release means Pollution Conditions from a Storage Tank System, including those from an overfill of a Storage Tank System, that has been investigated and confirmed by or on behalf of the Insured during the Policy Period through a system tightness test, site check, or other procedure approved by the Implementing Agency in accordance with Environmental Law. E. Corrective Action means: 1. Reasonable and necessary costs for response, abatement, investigative, and removal actions resulting from a Confirmed Release as legally required by Subpart F of the federal underground storage tank regulations, 40 C.F.R. 280.60 through 280.66, and 280.72, or as legally required by other applicable federal regulations or by other applicable regulations promulgated by a state under! an underground storage tank program approved by the United 1 States Environmental Protection Agency in accordance with Section 9004 of the Resource Conservation and Recovery Act of 1976, as amended; 2. Reasonable and necessary costs for the cleanup, pursuant to a written order from the Implementing Agency and with the prior written approval of the Company, of Pollution Conditions in soil or groundwater due to a Confirmed Release, including the preparation, development, modification and implementation of a "corrective action plan" as defined in 40 C.F.R. 280.66, and the monitoring, evaluation and reporting of the results 'of the implementation of such plan. 'F. Environmental Laws means any federal, state, provincial or local laws (including, but not limited to, statutes, rules, regulations, ordinances, guidance documents, and governmental, judicial or administrative orders and directives) that are applicable to Pollution Conditions. 811061(10/05) CI2766 10 G. Extended Reporting Period means either the automatic additional period of time or the optional additional period of time, whichever is applicable, in which to report Claims or Confirmed Releases ' following termination of coverage, as described in Section VII. of this Policy. ' II. Implementing Agency means the Federal Environmental Protection Agency or a state or local agency having jurisdiction pursuant to Environmental Laws. I. Inception Date means the first date set forth in Item 2 of the Declarations. J. Insured means the Named Insured, and any past or present director, officer, partner or employee thereof, including a temporary or leased employee, while acting within the scope of his or her duties as such. K. Insured Contract means a contract or agreement submitted to and approved by the Company, and listed on a Scheduled Insured Contract Endorsement to this Policy. L. Loss means, under the applicable Coverages: 1. Monetary awards or settlements of compensatory damages; where allowable by law,'punitive, exemplary, or multiple damages; and civil fines, penalties, or assessments for Bodily Injury or Property Damage; or 2. Clean-Up Costs or Corrective Action. M. Named Insured means the person or entity named in Item 1 of the Declarations acting on behalf of all other Insureds, if any, for the payment or return of any premium, payment of any deductible, receipt and acceptance of any endorsement issued to form a part of this Policy, giving and receiving notice of cancellation or nonrenewal, and the exercise of the rights provided in the Extended Reporting Period clause. N. Policy Period means the period set forth in Item 2 of the Declarations, or any shorter period arising as a result of: 1. Cancellation of this Policy; or 2. With respect to particular Storage Tank System(s): (a) the deletion or addition of such Storage Tank System from this Policy by the Company, at the Named Insured's written request, but solely with respect to that Storage Tank System. (b) the sale, giving away or abandonment of a Storage Tank System, or the sub-leasing of such Storage Tank System, unless the sub-lease has been approved in writing by the Company priori to the commencement of the sub-lease. O. Pollution Conditions means the discharge, dispersal, release or escape of any solid, liquid, gaseous or thermal irritant or contaminant, including, but not limited to, smoke, vapors, soot, fumes,' acids, alkalis, toxic chemicals, medical waste and waste materials into or upon land, or any structure on land, the atmosphere or any watercourse or body of water, including groundwater, provided such Hi conditions are not naturally present in the environment in the amounts or concentrations discovered. 8110611(10/05) CI2766 it P. Property Damage means: 1. Physical injury to or destruction of tangible property of parties other than the Insured including the resulting loss of use thereof; 2. Loss of use of tangible property of parties other than the Insured that has not been physically injured or destroyed; Property Damage does 'not include Clean-Up Costs or Corrective Action. Q. Responsible Insured means the manager or supervisor of the Named Insured responsible for environmental affairs, control or compliance, or any owner or operator of a Storage Tank System, or any officer, director or partner of the Named Insured. R. Restoration Costs means reasonable and necessary costs incurred by the Insured with the Company's written consent, which consent shall not be unreasonably withheld or delayed, to repair, replace or restore real or personal property to substantially the same condition it was in prior to being damaged during work performed in the course of incurring Clean-Up Costs or Corrective Action. However, such Restoration Costs shall not exceed the net present value of such property prior to incurring Clean-Up Costs or Corrective Action. Restoration Costs do not include costs associated with improvements or betterments. S. Storage Tank System means a stationary tank or tanks owned or operated by the Insured and shown in Item 5 of the Declarations. Storage Tank System includes any on site integral piping or dispensing equipment, ancillary equipment and containment system associated with the tanks. T. Tank Fund means any state storage tank trust fund, state administered insurance program, or restoration funding for Storage Tank Systems whose owners qualify for reimbursement, or any self insurance fund established for the purpose of funding Clean-Up Costs or Corrective Action for Pollution Conditions from a Storage Tank System. The remainder of this page has been intentionally left blank. Policy Signature Page shall immediately follow. 81 1061(10/05) CI2766 12 AIG ENVIRONMENTAL NOTICE OF LOSS/NOTICE OF CLAIM INSTRUCTIONS: PLEASE ATTACH ALL CORRESPONDENCE RELATING TO THIS NOTICE OF LOSS AND MAIL COPIES OF THIS NOTICE' TO EACH ADDRESS BELOW: Manager, Pollution Insurance Products Unit AIG Domestic Claims, Inc. PIP Claims Department 101 Hudson Street, 31'Floor Jersey City, NJ 07302 Fax Number: 866-947-1377 Email: PIPCLAIMS.reporting®aig.com Date of Notice: NAMED INSURED: Telephone: ( ) Contact: ' ADDRESS OF INSURED: BROKER NAME: Telephone: ( ) Contact: BROKER ADDRESS: POLICY INFORMATION: Policy Number: Policy Period: From: To: Loss Information: Loss Location: Date&Description of Loss: For AIG Use Only: Date Claim Notice Received: Date of Claim: _ Company/Person Filing Suit(if applicable): NOTE:Any:person who knowingly files a Statement of Claim containing any false or misleading information is subject to criminal and civil penalties. 91968 (12/06) PAGE 1 OF 1 CI2940 • FORMS SCHEDULE Named Insured: City of Renton Policy Number: 007786457 Effective 12 :01 AM: 01/01/08 Form Number/ Form Name Edition Date C&I Storage Tank 3rd Party Liability Decpage 81206 (11/02) C&I Storage Tank 3rd Party Liability Policy 81106 (10/05) Notice of Loss/Notice of Claim 91968 (12/06) CI2940 Site Schedule 81029 (10/02) Schedule of Covered Storage Tank Systems 81017 (10/02) Separation of Insureds 'Endorsement 81026 (10/02) Limitation of Loss for Cert. Acts of Terrorism 81290 (12/02) Coverage Territory Endorsement 89644 (07/05) Washington Amendatory Endorsement 81048 (10/02) Washington Cancellation/Nonrenewal Amen. Endt 78804 (10/03) CIFMSC CI0226 ENDORSEMENT This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy No: 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company AIG ENVIRONMENTAL STORAGE TANK THIRD-PARTY LIABILITY AND CLEAN-UP COSTS POLICY SITE SCHEDULE Site# Facility Name/Address, City, State, Zip 1 1 Maplewood Golf Course 400 Maple Valley Hwy Renton, WA 98055 2 P/B/PW 3555 NE 2nd Street Renton, WA 98056 All other terms, conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81029+(10/02) CI2254 ENDORSEMENT This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy1No: 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF COVERED STORAGE TANK SYSTEMS It is agreed that any previous Schedule of Coverage Storage Tank Systems is deleted in its entirety and replaced with the following: The following Storage Tank System(s) are included in Item 5 . COVERED STORAGE TANK SYSTEM(S) 'of the Declarations, subject to all of the terms and conditions of the Policy and the Policy Period and Retroactive date indicated below. If no dates are indicated below for Policy Period for a subject Storage Tank System, the dates indicated in Item 2 . Policy Period of the Declarations shall apply. If no date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6 . Retroactive Date of the Declarations shall apply. If a Policy Period is indicated below for a subject ,Storage Tank System, Item. 2 Policy Period of the Declarations is deleted in its entirety and replaced with the Policy Period, below, for such Storage Tank System. If a date is indicated below for Retro Date for a subject Storage Tank System,, the date indicated in Item 6 . Retroactive Date of the Declarations is deleted in its entirety and replaced with Retro Date, below, for such Storage Tank System. Site* Tank AST/ Install Capacity Tank Effective Expiration Retro # # UST Date (Gal. ) Const. Date Date Date 1 1 UST 1991 550 DF 1/01/08 01/01/09 61/10/91 2 1 UST 1985 12, 000 DF 1/01/08 01/01/09 6/10/91 2 2 UST 1985 12, 000 DF 1/01/08 01/01/09 6/10/91 *Site#, name and address are located within the Site Schedule attached to the Policy. All other terms, conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81017(10/02) CI2253 ENDORSEMENT This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy No. : 007786457 Issuied to: City of Renton By: Commerce and IndustryInsurance Company Y P Y THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SEPARATION OF INSUREDS CONDITION ENDORSEMENT It is hereby agreed that the Policy is amended by the addition of the following condition to Section VI. CONDITIONS: Separation of Insureds - It is hereby agreed that except with respect to the Limit of Liability, Section II. E. (Insured vs. Insured exclusion), and any rights and duties specifically assigned to the first Named Insured, this insurance applies: 1. 1 As if each Named Insured were the only Named Insured; and 2. Separately to each Named Insured against whom a Claim is made. Misrepresentation, concealment, breach of a term or condition, or violation of any duty under this Policy by,one,Named Insured shall not prejudice the interest of coverage for another Named Insured under this Policy. Provided, however, that this Condition shall not apply to any Named Insured who is a parent, subsidiary or affiliate of the first Named Insured. i I All other terms,conditions,and exclusions shall remain the same. 111 AUTHORIZED REPRESENTATIVE or countersignature(in states where applicable) 81026(10/02) PAGE 1 OF 1 C11904 ENDORSEMENT NO. This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy No. : 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITATION OF LOSSES FOR CERTIFIED ACTS OF TERRORISM Our liability for loss, injury, damage, claim or suit, arising directly or indirectly as a result of or in connection with a certified "act of terrorism" defined by Section 102. Definitions., of the Terrorism Risk Insurance Act of 2002 (the Act), and any revisions or amendments, is limited by Section 103. Terrorism Insurance Program, of the Act. All other terms, conditions, and exclusions shall remain the same. //&."—eeZZ4' AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81290 (12/02) PAGE 1 OF 1 CI1980 ENDORSEMENT NO. This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy No. : 007786457 Issued to: City of Renton By: bommerce and Industry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE TERRITORY ENDORSEMENT PayMent Of loss under this policy shall only be made in full compliance with all United States of America economic'or trade sanction laws or regulations, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department's Office of Foreign Assets Control("OFAC"). All other terms,conditions, and exclusions shall remain the same. 1,1 AUTHORIZED REPRESENTATIVE 11, or countersignature(in states where applicable) 89644(7/05) PAGE 1 OF 1 C 12771 ENDORSEMENT NO. This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy� No. : 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTONAMENDATORY ENDORSEMENT It is hereby agreed that the Policy is amended as follows: 1. The second sub-paragraph of Section VI. CONDITIONS, Paragraph B. Subrogation; is deleted in its entirety and replaced with the following: In the levent of any recovery by the Company as result of subrogation proceedings arising out of a Loss, Clean-UP Costs or Corrective Action covered under this Policy, the Company shall, from the funds collected, first pay to the Insured the applicable deductible paid by the Insured less the prorated share of subrogation expenses and only thereafter retain any funds in excess of the deductible portion of the recovery. 2. Section VI. CONDITIONS,, Paragraph N. Choice of Law, is deleted in its entirety. All other terms and conditions shall remain the same. 111 AUTHORIZED REPRESENTATIVE or countersignature (instates where applicable) 11 81048 (10/02) CI1926 I ENDORSEMENT NO. This endorsement, effective 12 :01 AM, 01/01/08 Forms a part of Policy! No. : 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company ,THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON AMENDATORY ENDORSEMENT ndused in this Iendorss�ement: 1) "Insurer" means the insurance company which issued'' this Wherever policy; ) "First Named Insured", and "Insured" mean the Named Corporation, Named Organization, Named Sponsor, Named Insured, Named Entity or Insured stated in the declarations page. The following is added and supersedes any provision to the contrary: A. CANCELLATION 1. The Insured may cancel this policy by mailing or delivering to the Insurer written notice of cancellation or by surrender of the policy prior to or on the effective date of such cancellation. 2. The Insurer may cancel this policy by mailing or delivering to the Insured and the Insured's "'representative in charge of the subject of the insurance, if applicable, written notice of cancellation, including the actual reason for the cancellation, to the last mailing address known to the Insurer, at least: a. 10 days before the effective date of cancellation if the Insurer cancels for nonpayment 'of premium; or b. 145 days before the effective date of cancellation if the Insurer cancels for any other reason. 3 Like notice of cancellation will also be mailed to any mortgage holder, pledgee or other person shown in this policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If notice is mailed, proof of mailing will be sufficient proof of notice. 6. If the policy is cancelled, we will send the first Named Insured any premium refund due. If the Insurer cancels, the refund will be pro rata. If the first Named Insured cancels, the refund will be at least 90% of the pro rata refund. The cancellation will be effective even if we have not made or offered a refund. B. NONRENEWAL 1. The Insurer may elect not to renew this policy by mailing or delivering written notice of nonrenewal, to the First 'Named Insured and the First Named Insured's representative in;charge of the subject of the insurance at their respective last mailing addresses known to the Insurer. The notice of nonrenewal shall state the actual reason for nonrenewal. The Insurer will also 78804 (10/03) Page 1 of'2 C12261 ENDORSEMENT NO. (Continued) mail to any mortgage holder or other person shown in this policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer, written notice of nonrenewal. The Insurer will mail or deliver these notices at least 45 days before the: i a. Expiration of the policy; or b. Anniversary date of this policy if this policy has been written for a term of more than one year. Otherwise, the Insurer will renew this policy unless: a. The Insured fails to pay the renewal premium after the Insurer has expressed willingness to renew and has sent a statement of the renewal premium to the Insured and the Insured's representative in charge of the subject of insurance at least 20 days before the expiration date; b. Other equivalent coverage has been procured by the Insured prior to the expiration date of the policy; or c. The contract is evidenced by a written binder containing a clearly stated expiration date which has expired according to its terms. All other terms and conditions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature(instates where applicable) 78804 (10/03) Page 2 of 2 C 12261 POLICY SIGNATURE PAGE This Policy Signature Page, forms a part of Policy No: 007786457 By signing below, the President and the Secretary of the Insurer agree on behalf of the Insurer to all the terms of this Policy. Zlij4),Airl '<AAA— v6stcik4rLr\,,14sysooi.-"'"-N.. Secretary President Commerce and Industry Insurance Company Commerce and Industry Insurance Company This Policy shall not be valid unless signed at the time of issuance by an authorized representative of the Insurer, either below or on the Declarations page of the Policy. Authorized Representative 86697(9/04) CI2469 Wi,m4•511WWWWWT rirankevg p Sp Storage'Tank Third Party Liability vy 1 TankGuard® Renewal Warranty Named Insured: City of Renton Insurer Commerce and Industry Insurance Company Policy number: PLC 7786457 Policy period: 1/01/08 to 1101/09 The undersigned warrants and represents that there have been no changes to the schedule of covered tanks or locations: THIS RENEWAL WARRANTY DOES NOT BIND THE APPLICANT TO BUY, OR THE COMPANY TO ISSUE THE INSURANCE, BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED, AND IT WE.!.BE ATTACHED TO THE ORIGINAL APPLICATION AND MADE A PART OF THE POLICY. THE UNDERSIGNED APPLICANT DECLARES, WARRANTS AND REPRESENTS THAT THE STATEMENTS SET FORTH IN THIS WARRANTY ARE TRUE AND THAT NO MATERIAL FACTS HAVE BEEN SUPRESSED OR MISSTATED. THE APPLICANT FURTHER DECLARES,WARRANTS AND REPRESENTS THAT IF TI•lE INFORMATION SUPPLIED ON THIS WARRANTY CHANGES BETWEEN THE EXECUTION DATE OF THE WARRANTY AND THE RENEWAL POLICY EFFECTIVE DATE,TI-IE APPLICANT WILL.IMMEDIATELY NOTIFY THE COMPANY OF SUCH CHANGES, AND THE COMPANY MAY WITHDRAW OR MODIFY ANY OUTSTANDING QUOTATIONS AND/OR AUTHORIZATION OR AGREEMENT TO BIND THE INSURANCE. ALL WRIT TIIN STATEMENTS AND MATERIALS FURNISHED TO THE COMPANY IN CONJUNCTION'WITH THE MOST RECENT LONG FORM APPLICATION AS WELL AS THE RENEWAL WARRANTY SIGNED HEREUNDER ARE INCORPORATED BY REFERENCE INTO THIS APPLICATION AND MADE A PART HEREOF. In the event that the company issues a policy, the undersigned acting on behalf of the applicant and all proposed insureds, acknowledges that the company, in providing coverage, will have relied upon, as representations, the declarations and statements which are contained in or attached to or incorporated by reference into this warranty and which are incorporated into the policy. If insured would like an indication for higher limits, please indicate. III LIMITS DESIRED: (each incident/aggregate) ( )$1 rnillion/$1 million ( )$1 million/$2 million ( )$1 million/$3 million ( ) $1 million/$5 million ( )$2 million/$2 million ( )$5 million/$5 million ( }OTHER: 9117,7(6/06) CI2865 • i - m -I 4c vUNAN W DEDUCTIBLE DESIRED: (each incident) ( ) $5,000 ( )$10,000 ( ) $25,000 ( ) $50,000 ( )$100,000 For Deductibles above$25,000,please include your most current audited financial statement. NOTICE TO APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR, CONCEALS, FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT ACT,WHICH IS 'A CRIME AND MAY SUBJECT SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES. NOTICE TO ARKANSAS AND NEW MEXICO APPLICANTS: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT, OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF,A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON. NOTICE TO COLORADO APPLICANTS: IT IS UNLAWFUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMATION TO AN INSURANCE COMPANY 'FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE COMPANY. l'PENALTIES MAY INCLUDE IMPRISONMENT, FINES, DENIAL OF INSURANCE, AND CIVIL DAMAGES. ANY INSURANCE COMPANY OR AGENT OF AN INSURANCE COMPANY WHO KNOWINGLY PROVIDES FALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMATION 7'O A POLICYHOLDER OR CLAIMANT FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE POLICYHOLDER OR CLAIMANT WITH REGARD TO A SETTLEMENT OR AWARD PAYABLE FROM INSURANCE PROCEEDS SHALL BE REPORTED TO THE COLORADO DIVISION OF INSURANCE WITHIN THE DEPARTMENT OF REGULATORY AUTHORITIES NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: WARNING: IT IS A CRIME TO PROVIDE FALSE OR MISLEADING INFORMATION TO AN INSURER FOR THE PURPOSE OF • DEFRAUDING THE INSURER OR ANY OTHER PERSON. PENALTIES INCLUDE 'IMPRISONMENT AND/OR FINES. IN ADDITION, AN INSURER MAY DENY INSURANCE BENEFITS IF FALSE INFORMATION MATERIALLY RELATED TO A CLAIM WAS PROVIDED BY THE APPLICANT- NOTICE TO FLORIDA APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT • TO INJURE, DEFRAUD, OR'DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY IN THE THIRD DEGREE. NOTICE TO KENTUCKY: APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE INFORMATION,OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO,COMMITS A FRAUDULENT INSURANCE ACT,WHICH IS A CRIME. „'NOTICE TO LOUISIANA APPLICANTS: ANY PERSON WHO KNOWINGLY PRESENTS A • FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON. 91177(6/06) CI2865 I< a 4 'u I NOTICE TO MAINE APPLICANTS: IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, ,INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES MAY INCLUDE IMPRISONMENT, FINES OR A DENIAL OF INSURANCE BENEFITS. NOTICE TO NEW JERSEY APPLICANTS: ANY PERSON WHO INCLUDES ANY FALSE OR MISLEADING INFORMATION ON AN APPLICATION FOR AN INSURANCE POLICY IS SUBJECT 'I'O CRIMINAL AND CIVIL PENALTIES. NOTICE TO NEW YORK APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH .INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMA'I'ION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT•,WHICH IS A CRIME,AND SHALL ALSO BE SUBJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS AND THE STATED VALUE OF TI•IE CLAIM FOR „EACH SUCH VIOLATION, , NOTICE TO OHIO APPLICANTS: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE.FRAUD. ' NOTICE TO OKLAHOMA APPLICANTS: WARNING:ANY PERSON WHO KNOWINGLY,AND WITH INTENT TO INJURE, DEFRAUD OR DECEIVE ANY INSURER, MAKES ANY CLAIM FOR THE PROCEEDS OF AN INSURANCE POLICY CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY(365:15-1-10,36 ti3613.1). ' NOTICE TO PENNSYLVANIA APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH ' INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN • • APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY • MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, • • INFORMATION CONCERNING ANY FACT MATERIAL THERETO COMMITS A FRAUDULENT • ',INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS SUCH PERSON TO CRIMINAL. AND CIVIL PENALTIES. • NOTICE TO TENNESSEE AND VIRGINIA APPLICANTS: IT IS A CRIME TO KNOWINGLY • PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES INCLUDE • IMPRISONMENT,FINES AND DENIAL OF INSURANCE BENEFITS. u 91177(6/06) CI2865 1/4,v " r� fir , ' = 1 I::li'':icu'it' t l`'C:,Ri'. :Pt=*''0@ RA�'M • Renewal Warranty. Acknowledgement APPLICANT. BROKER: WA( t'�_�1/.(,1. /I ��; /1/,t'/f/�!(fdlY '� Signature) lu DATE: APPLICANT: . �� 1 ._�` L "" 1 65 u. �, .L6g vlf h.;,( t.C-t 01,1 2k0667 __ R.,...l,,,k-Dc, (Print Name) 1/ ��P�� ilpt t14�J i i } �0 r a-. y V /l (Con ct Person) (Phone#,Fax it,Email Address) �_ (Signature of Broker or Agent) y V` f� _,_1_c24_ I (L.icense Number and State) fii' 11,,. (Tax LIB.ft) Please note that if you are planning on adding either additional tanks or locations to this policy, the Company requires that we first receive a fully complete renewal application within thirty (30) days of the policy expiration date. Please visit our website www.chamberagent.com to download the application. . i 1 91177(6/06) CI2865 CERTIFICATE OF INSURANCE WASHINGTON Name: City of Renton Address: See Schedule Below Policy Number: 007786457 Endorsement: Not Applicable Period of Coveragel: From 01/01/08 To 01/01/09 Name Of Insurer: Commerce and Industry Insurance Company Address Of Insurer: 70 Pine Street New York, NY 10270 Name Of Insured: City of Renton Address Of Insured: 1055 South Grady Way Renton, WA 98055 CERTIFICATION: 1. COMMERCE & INDUSTRY INSURANCE COMPANY, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s) : See "Item 5 . Covered Storage Tank System(s) " on policy referenced above, For "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 $ 2, 000, 000 each occurrence and $ 2, 000, 000 annual aggregate exclusive of legal defense costs which are subject to a separate limit under the policy. This coverage is provided under 007786457. The effective date of said policy is 01/01/08. 2 . The Insurer 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 of its obligations under the policy to which this certificate applies. b. The Insureriis liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or damaged third-party with a right of reimbursement by the Insured' for any such payment made by the Insurer. 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 WAC 173- 360-413 through 173-360-433 . c. Whenever requested by the Director of Washington State Department of Ecology, the Insurer agrees to furnish the Director a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non-payment of premium or misrepresentation by the Insured, will be effective only upon written notice and only after the expiration of sixty(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 ten(10) days after a copy of such written notice is received by the Insured. e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or 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 an 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 WAC 173-360-480 and that the Insurer is licensed to transact the business of insurance in on or more states. Signature of Authorized Representative of Insurer Sean M. Pattwell The Director Authorized Representative of Commerce & Industry Insurance Company Chamber Insurance Agency Services 100 Executive Drive, Suite 200 West Orange, NJ 07052 89720 (8/05) CI2741 I 4 CERTIFICATE OF INSURANCE WASHINGTON Name: City of Renton Address: See Schedule Below Policy Number: 007786457 Endorsement: Not Applicable I Period of Coverage: From 01/01/08 To 01/01/09 Name Of Insurer: Commerce and Industry Insurance Company( Address Of Insurer: 70 Pine Street New York, NY 10270 Name Of Insured: , City of Renton Address Of Insured: 1055 South Grady Way Renton, WA 98055 CERTIFICATION: 1. COMMERCE & INDUSTRY INSURANCE COMPANY, the Insurer, as identified (above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s) : See "Item 5 . Covered Storage Tank S stem s " on policyreferenced g y ( ) above, For "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 $ 2, 000, 000 each occurrence and $ 2, 000, 000 annual aggregate exclusive of legal defense costs which are subject to a separate limit under the policy. This coverage is provided under 007786457. The effective date of said Policy is 01/01/08 . 2 . The Insurer 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 of its obligations under the policy to which this certificate applies. b. The Insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or damaged third-party with a right of reimbursement by the Insured for any such payment made by the Insurer. 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 WAC 173- 360-413 through 173-360-433 . 89720 (8/05) CI2741 ti 1 c. Whenever requested by the Director of Washington State Department of Ecology, the Insurer agrees to furnish the Director a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non-payment of premium or misrepresentation by the Insured, will be effective only upon written notice and only after the expiration of sixty(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 ten(10) days after a copy of such written notice is received by the Insured. e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or 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 an 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 WAC 173-360-480 and that the Insurer is licensed to transact the business of insurance in on or more states. � I /1e, ^ I Signature of Authorized Representative of Insurer Sean M. Pattwell The Director I Authorized Representative of Commerce & Industry Insurance Company Chamber Insurance Agency Services 100 Executive Drive, Suite 200 West Orange, NJ 07052 89720 (8/05) CI2741 I ENDORSEMENT This endorsement, effective 12 : 01 AM, 01/01/08 Forms a part of Policy No: 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company AIG ENVIRONMENTAL STORAGE TANK THIRD-PARTY LIABILITY AND CLEAN-UP COSTS POLICY SITE SCHEDULE Site# Facility Name/Address, City, State, Zip 1 , Maplewood Golf Course 400 Maple Valley Hwy Renton, WA 98055 2 P/B/PW 3555 NE 2nd Street Renton, WA 98056 Allother terms, conditions, and exclusions shall remain the same. I i AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) III 81029 (10/02) CI2254 ENDORSEMENT This endorsement, effective 12 : 01 AM, 01/01/08 Forms a part of Policy No: 007786457 Issued to: City of Renton By: Commerce and Industry Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF COVERED STORAGE TANK SYSTEMS It is agreed that any previous Schedule of Coverage Storage Tank Systems is 'deleted in its entirety and replaced with the following: The, following Storage Tank System(s) are included in Item 5 . COVERED STORAGE TANK SYSTEM(S) of the Declarations, subject to all of the terms and, conditions of the Policy and the Policy Period and Retroactive date indicted below. If no dates are indicated below for Policy Period for a subject Storage Tank System, the dates indicated in Item 2 . Policy Period of the Declarations shall apply. If no date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6 . Retroactive Date of the Declarations shall apply. If a Policy Period is indicated below for a subject Storage Tank System, Item. 2 Policy Period of the Declarations is deleted in its entirety and replaced with the Policy Period, below, for such Storage Tank System. If a date is indicated below for Retro Date for a subject Storage Tank System, the date indicated in Item 6 . Retroactive Date of the Declarations is deleted in its entirety and replaced with Retro Date, below, for such Storage Tank System. Site* Tank AST/ Install Capacity Tank Effective Expiration Retro #1 # UST Date (Gal. ) Const. Date Date Date 1 1 UST 1991 550 DF 1/01/08 01/01/09 6/10/91 2 1 UST 1985 12, 000 DF 1/01/08 01/01/09 6/10/91 2 ' 2 UST 1985 12, 000 DF 1/01/08 01/01/09 6/10/91 *Site#, name and address are located within the Site Schedule attached to the' Policy. Alliother terms, conditions, and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 81017 (10/02) CI2253