EMERGENCY RESPONSE TOWING VESSEL (ERTV) ENROLLMENT AGREEMENT

Schedule of Vessel Information

Vessel’s Name: Cargo Oil (if applicable): Flag (Port of Registry): Vessel’s Cargo Oil Capacity: BBLS Official or IMO Number: Type of Oil Carried (check all that apply) Gross Registered Tons: ☐ Crude Oil Deadweight Tons (DWT): ☐ Product (list oil products carried): Vessel characteristics information will be verified using Lloyds Will Vessel Call in Washington ports of the Puget Sound ☐ Non-Petroleum Oil (list): region via Strait of Juan de Fuca? ☐ Yes ☐ No Fuel Oil: (if not, ERTV enrollment and this Schedule are not necessary) Vessel’s Fuel Oil Capacity: BBLS Vessel Type (check type): Type of Fuel Oil Carried ☐ Tank Ship (carrying oil of any kind as cargo) ☐ Tank Ship (not carrying oil as cargo) Worst Case Discharge (WCD) for oil spill contingency ☐ Tank Barge (carrying oil of any kind as cargo) planning purposes: BBLS ☐ Articulated Tug and Barge (carrying oil as cargo) Oil capacities and WCD are validated using information ☐ Gas Carrier on the Coast Guard Vessel Response Plan website ☐ Passenger Vessel ------☐ Container Ship OIL SPILL RESPONSE COVERAGE: ☐ Ro/Ro USCG Vessel Response Plan (VRP) Control No: ☐ Car Carrier ☐ Bulk Carrier Washington State Approved Oil Spill Vessel Response Plan: ☐ Break Bulk Cargo Carrier ☐ Vessel/Company Plan ☐ Towing Vessel ☐ Washington State Maritime Cooperative Plan ☐ Fishing Industry Vessel ☐ National Response Corporation Plan ☐ Other (describe): Ship Owner/Operator Company Name: Vessel’s P&I Club or Insurer:

Owner/Operator Mailing Address: Qualified Individual (QI) Provider listed in VRP: Company Name: QI Name (if applicable): QI 24/7 Phone No.: Owner/Operator Telephone No: Owner/Operator Facsimile No: Information on which ERTV Fee Credits may apply: Owner/Operator Email Address: • Oil cargo tank protection: Does vessel have double hull oil cargo tanks? Authorized Agent Company (if other than Owner/Operator) ☐ Yes ☐ No • Fuel tank protection: Authorized Agent Address: Does vessel have double hull fuel tanks? ☐ Yes ☐ No • Propulsion: Vessel has totally independent dual propulsion Authorized Agent Telephone No: ☐ Yes ☐ No Authorized Agent Facsimile No: • Safety/Environmental Systems Certification: Authorized Agent Email Address: ISO 14001: ☐ Yes ☐ No ECOPRO (applies to tank vessels): ☐ Yes ☐ No Other: Method of ERTV Transit Notice: ☐ 96 Hour Notice to USCG For ERTV CG (Marine Exchange) use ☐ Direct Notice to ERTV Non-tank vessel first annual transit fee: $ Non-tank vessel general transit fee: $ Tank vessel transit fee: $ Revised 12-30-2013