ERS/ERTV SCHEDULE OF VESSEL INFORMATION
Emergency Response System/Towing Vessel (ERS/ERTV) Enrollment Agreement
Vessel"s Name:
*
Official or IMO Number:
*
Vessel Flag:
*
US
FOREIGN
Gross Registered Tons (GRT):
*
Deadweight Tons (DWT)
*
Build Date:
VESSEL TYPE:
*
Tank Ship (carrying oil of any kind as cargo)
Tank Ship (not carrying oil as cargo)
Tank Barge carrying oil as cargo
Articulate Tug and Barge (carrying oil as cargo)
Gas carrier
Passenger Vessel
Container Ship
Ro/Ro
Car Carrier
Bulk Carrier
Break Bulk Cargo Carrier
Towing Vessel
Fishing Industry Vessel
Other
Vessel characteristics information will be validated using Lloyds
Ship Owner/Operator Company Name:
*
Ship Owner/Operator Mailing Address:
*
Ship Owner/Operator Telephone No.:
*
Ship Owner/Operator Facsimile No.:
Ship Owner/Operator Email Address:
*
Authorized Agent Company (if other than Ship Owner/Operator Company)
Name of Authorized Agent:
Authorized Agent Address:
Authorized Agent Telephone No.:
Authorized Agent Facsimile No.:
Authorized Agent E-mail Address
Fuel Oil: Vessel"s Fuel oil Capacity:
*
Type(s) of Fuel Oil Carried:
*
Bulk Oil: Does this vessel carry any bulk oil as cargo?
YES
NO
If YES: Vessel"s Bulk Oil Cargo Capacity ( BBLS )
If YES: Vessel"s type of Bulk Oil Cargo
WORSE CASE DISCHARGE (WCD): BBLS
*
Oil capacities and Worst Case Discharge quantities are verified through the USCG's VRP website
OIL SPILL RESPONSE PLAN COVERAGE:
USCG Response Plan (VRP) Control Number:
WASHINGTON STATE APPROVED VESSEL RESPONSE PLAN:
Vessel/Company Plan:
*
YES
NO
Washington State Maritime Cooperative Plan:
*
YES
NO
National Response Corporation Plan:
*
YES
NO
Vessel"s P&I Club or Insurer:
*
Qualified Individual Provider listed in VRP (Company Name):
*
QI (Individuals name if applicable):
QI 24/7 Phone Number:
*
Information on which ERS/ERTV FEE credits may apply:
Fuel tank protection: Does vessel have protectively located fuel oil tanks per Regulation 12A?
YES
NO
Propulsion: Does vessel have totally independent dual propulsion?
YES
NO
Safety/Environmental Systems Certification:
ISO 14001:
YES
NO
ECOPRO (applies to tank vessels):
YES
NO
Other:
Submit
Should be Empty: