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<br />Insured Name: CALDWELL FIRE DEPARTMENT, INC <br />Tuesday, March 11, 2025 Page 16 <br />Each Occurrence or Medical Incident:$300,000 <br />$500,000 <br />$1,000,000 <br />General Aggregate:$1,000,000 <br />$2,000,000 <br />$3,000,000 <br />$10,000,000 <br />Medical Expense:$5,000 <br />$10,000 <br />Line of Duty Accidental Death Benefit:$10,000 <br />Not Included <br />Employer's (Stop Gap) Liability: Yes No <br />If yes, provide current payroll: <br />Pollution Liability – Above Ground Storage Tanks: Yes No <br />If yes, do you routinely monitor the tank(s) to ensure they are not <br />leaking? Yes No <br />If Yes, how frequently <br />Do employees know and follow release reporting, <br />investigation and confirmation procedures? Yes No <br />Pollution Liability Exclusion – Class B Firefighting Foam: <br />In your inventory, do you have any Class B foam? Yes No <br />If yes, how many gallons? <br />Is the foam labeled "Fluorine Free"? Yes No <br />If no, have these foam containers been isolated within a leak containment <br />enclosure and removed from use (fire ground, training, etc.)? Yes No <br />Do you have a plan to properly dispose of this foam? Yes No <br />If yes, when and how? <br />Liquor Liability: Which of the following best describes the organization’s use of alcoholic beverages? <br />The organization sells alcohol year-round (bar or club). <br />Total Receipts: <br />License/Permit required by state: Yes No <br />License/Permit obtained: Yes No <br />U <br />U <br />Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF