(619) 222-1944
Toggle navigation
About
Products
Links
Contact Us
Home
Forms
Oil Pollution Application
Oil Pollution Application
U.S. Oil Pollution Act of 1990
Step
1
of
2
50%
Applicant Name
First
Last
Applicant Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Phone
*
Effective Date
MM slash DD slash YYYY
Vessel Description
Name
*
GRT
Year Built/Rebuilt
Construction
Self-Propelled?
Yes
No
Description of Operations
Pollution Loss History
Current Pollution Carrier & Dates
Current Protection & Indemnity Carrier & Dates
Under OPA 1990, a
"tank vessel"
is a vessel constructed or adapted to carry or that carries oil or hazardous material in bulk as cargo or cargo residue,
AND
that
(A)
is a vessel of the United States;
(B)
operates on the navigable waters; or
(C)
transfers oil or hazardous material in a place subject to the jurisdiction of the United States.
Is this vessel a “tank vessel”?
Yes
No
Will it carry any oil (including gas, diesel, fuel) in containers on deck?
Yes
No
Does the vessel carry hazardous material?
Yes
No
Latest survey date
MM slash DD slash YYYY
Have the recommendations been complied with?
(A copy of the survey may be requested by the Underwriters.)
Limit Requested
OPA 1990 Responsibility Requirements:
(a) Double Skin Tank Vessels 3,000 GRT or less: $2,000 per GRT or $4,272,000., whichever is greater
(b) Double Skin Tank Vessels OVER 3,000 GRT: $2,000 per GRT or $17,088,000., whichever is greater
(c) Single Skin Tank Vessels 3,000 GRT or less: $3,200 per GRT or $6,408,00., whichever is greater
(d) Single Skin Tank Vessel OVER 3,000 GRT: $3,200 per GRT or $23,496,000., whichever is greater
(e) ALL OTHER VESSELS: $1,000 per GRT or $854,400., whichever is greater
Tank Vessel will carry
Under 10,000 gallons
Under 25,000 gallons
Under 50,000 gallons
Under 100,000 gallons
Hull construction of Tank Vessel
Single Hull
Double Hull
Double sides only
Double bottom only
Details of the operations involving the transportation of the oil, gas, diesel, fuel, or other hazardous materials on deck
Signature
*
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
Δ
Forms
Application for Marine Insurance
Owner’s / Skipper’s Questionnaire
Sportfishing/Charter Vessel Application
Yacht Proposal Application
Yacht Additional Information Questionnaire
Application for Marine Artisans / Marina Operators
Application for Marina Operators
Maritime Employers’ Liability Application
Roto-Wing Aviation Application
Fixed Wing Aviation Application
Oil Pollution Application
Fishing Nets Application
Electronics Application
Cargo Insurance Application
Aquaculture Application
Some icons made by
Freepik
from
www.flaticon.com
and are licensed by
CC BY 3.0
Pin It on Pinterest