To ensure we can give best service and provide competitive quotations we require our Proposal Form to be fully completed. Please use additional sheets if necessary to provide full details, as without this information we regret we are unable to provide a quotation.  Please complete a separate form for each D-Code of fuel.

Serial Numbers of RINs to be insured:  

 

 

Fuel D-Code:

 

 
Your Company Name:  

 

Your Company FEIN (Federal Employers Identification Number):  
Your Company ID number in the ETMS:  
Your Company Address:  

 

What % of RINs are being insured relative to your RVO?  
Where have you obtained the RINs from?  Please provide the Company name, FEIN and ETMS Company and Facility numbers.  
Are these RINs Q-RINs?  
Do you have a due diligence process in place for each purchase/sale transaction you undertake? Please provide details.  
Has the Company incurred any losses (including potential losses) or been involved in any investigations relating to RIN invalidations?  Please provide details.  
Do you have an active QRIN program in place? If so, please provide details:  

 

 

Please provide details of any previous RIN invalidations / losses, including potential losses and investigations:  

 

 

 

Please provide details of your reporting and compliance monitoring.  

 

 

 

 

 

Please enclose the following documents:

  • Last full year of audited financial statements.
  • RIN sale and purchase contracts.
  • Details of your due diligence process.

 

 

 

DISCLOSURE OF MATERIAL INFORMATION

 

It is essential that every proposer or insured, when seeking a quotation, taking out or renewing an insurance, reveals to prospective insurers any material facts or information (including any material circumstance or change in circumstance) which might influence the judgement of an insurer in fixing the premium or in determining whether he will accept the risk. Failure to do so may render the contract of insurance voidable from inception at the discretion of the insurers.

 

If you have any doubt as to what constitutes a material fact or circumstance, you should seek advice from an insurance broker.