Forms

APPLYING FOR COVERAGE

  APPLICATION FOR COVERAGE - AST

(Application for coverage to meet financial responsibility requirements for new AST applicants.)

  APPLICATION FOR COVERAGE - UST

(Application for coverage to meet financial responsibility requirements for new UST applicants.)

  APPLICATION FOR COVERAGE - UST

(Application for coverage to meet financial responsibility requirements for "previously insured" UST sites.)

  CERTIFICATION OF KNOWN PETROLEUM CONTAMINATION

  HOW DO I APPLY?

  HOW TO ANALYZE YOUR SITE

How to analyze your site for petroleum contamination.

  MARINA CHECKLIST

(for new sites applying for coverage)

  METHODS OF LEAK DETECTION

  OWNERSHIP BACKGROUND INFORMATION

  RENEWAL APPLICATION

CLAIMS

  CLAIM ASSIGNMENT FORM (new)

  INSURANCE CLAIM FORM

  PMMIC CLAIMS PROCEDURES

  REPORTING CLAIMS

INSPECTIONS

  AUTHORIZATION TO RELEASE INSPECTION INFO TO IDNR

  FREQUENT WALK-THROUGH INSPECTIONS

MONITORING

  CATHODIC PROTECTION MONITORING LOG

  GROUNDWATER OR VAPOR MONITORING LOG

  LINE LEAK DETECTION LOG

  METHODS OF LEAK DETECTION

  PMMIC LINE LEAK DETECTION LOG

Secondary Containment with Interstitial Monitoring

  PMMIC LINE LEAK DETECTION LOG

PMMIC Line Leak Detection Log INCON / Campo Miller

  PMMIC TANK LEAK DETECTION LOG

Secondary Containment with Interstitial Monitoring

  PMMIC TANK LEAK DETECTION LOG

Temporary ATG Leak Test Report

  PMMIC TEST REPORTING FORM

Red Jacket PPM-4000/RLM-9000 Annual Line Test & Electronic Line Leak Detector

MISCELLANEOUS POLICY FORMS

  ATG CERTIFICATION FORM

  CERTIFICATION OF TOTAL CONTAINMENT PIPING REPLACEM

  DOCUMENTATION OF OVERFILL PREVENTION IN UST SYSTEM

  NOTIFICATION OF CONTRACTUAL AGREEMENT -PIPING

  NOTIFICATION OF SITE WORK

  UST SYSTEM COMPATIBILITY ASSESSMENT FORM

  PMMIC PREMIUM CREDIT FORM

IDNR & EPA FORMS

  IDNR 148 FORM-NEW

  IDNR CATHODIC PROTECTION INSPECTION FORM

  IDNR ETHANOL CHECKLIST

  IDNR ETHANOL CONVERSION

  IDNR ETHANOL INSPECTION FORM

  IDNR TEMPORARY CLOSURE FORM

  IDNR INSTALLER INSPECTOR CHECKLIST

  IDNR NOTIFICATION OF INTENT TO INSTALL

  IDNR FLOOD CERTIFICATION FORM.2008

  IDNR RETURN TO SERVICE FORM

  NESHAP NOTIFICATION FOR GASOLINE DISPENSING FACILITIES (GDF)

  IDNR CHANGE OF OWNERSHIP FORM

PMMIC POLICIES & NOTICES

  PMMIC POLICY (AST) 2007

  PMMIC POLICY (UST) 2005

  PMMIC PRIVACY NOTICE

POLICY CHANGES & AUTHORIZATIONS

  ADDITIONAL INSUREDS

Additions / Deletions

  AUTHORIZATION TO RELEASE INFORMATION TO IDNR

  AUTHORIZATION TO RELEASE POLICY INFORMATION

  ID NUMBER CHANGE REQUEST

  PREMIUM INVOICE - ADDITIONAL INSURED

  REQUEST FOR CANCELLATION OF PMMIC POLICY