Agr Form 702 4279 – Fill Out and Use This PDF

The AGR Form 702 4279 is Washington State's Financial Responsibility Insurance Certificate (FRIC) for licensed commercial pesticide applicators. It proves to the WSDA Pesticide Management Division that you carry adequate liability insurance or a surety bond covering bodily injury and property damage from pesticide applications. You must file this form before your commercial applicator license is issued and again at each renewal. Your insurance agent or bonding company completes and submits the certificate directly to the WSDA on your behalf.

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Agr Form 702 4279 PDF Details

The Agr 702 4279 form is required by the Washington State Department of Agriculture Pesticide Management Division. It certifies that commercial pesticide applicators hold adequate financial coverage for damage their work may cause. This includes bodily injury claims and property damage arising from pesticide applications.

The certificate requires either a general liability policy with a pesticide endorsement or a surety bond. Both options must meet minimum coverage amounts set by the WSDA. The policy or bond must name the Washington State Department of Agriculture as a certificate holder. Your insurance agent or bonding company completes the submission on your behalf.

The AGR 702 4279 distinguishes between standard commercial pesticide coverage and coverage for wood destroying organism (WDO) inspections. Applicators who perform complete WDO inspections during real estate transactions face higher minimum coverage requirements. The form applies to both new applicants and those completing license renewals.

Question	Answer
Form Name	Agr Form 702 4279
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	syngenta principal certificate, principal certificate, pesticides principal certificate, principal certificate for seeds

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COMMERCIAL

PESTICIDE APPLICATORS

FINANCIAL RESPONSIBILITY

INSURANCE CERTIFICATE (FRIC)

Washington State Department of Agriculture Pesticide Management Division PO Box 42560 • Olympia, WA 98504-2560 Toll Free 877-301-4555 FAX (360) 902-2093

E-Mail: license@agr.wa.gov

Important: This FRIC is for Commercial Applicators who apply pesticides. There are separate forms used to verify coverage for individuals

who perform wood destroying organism (WDO) inspections. A Commercial Applicator who applies pesticides and conducts complete WDO inspections must meet the inancial coverage requirements of both the Commercial Applicator and the Structural Pest Inspector license.

Complete WDO inspections are done for the purpose of determining evidence of infestation, damage, or conducive conditions as part of the transfer, exchange, or reinancing of any structure. For further information on the inancial coverage requirements and options for

both licenses, go to http://agr.wa.gov/PestFert/LicensingEd/CaSpiInfo.aspx.

WSDA accepts faxes, e-mails and copies of this completed form.

Instructions: This form is only valid when completed by the Commercial Applicator's Insurance Agent. For new licenses, this form must be submitted BEFORE the Commercial Applicator license can be issued. For existing licenses, it must be submitted by the expiration date of the Commercial Applicator's insurance policy or that license is automatically suspended.

Washington pesticide law (Chapter 17.21 RCW) requires that all Commercial Applicators submit proof of inancial responsibility. Com- mercial Pesticide Applicators must have a surety bond or liability insurance policy that covers the pesticide applications of the business in the amount of at least $50,000 per occurrence for bodily injury and $50,000 per occurrence for property damage including loss of damage arising out of the actual use of any pesticide not excluded below, including chemical drift damage onto property other than the property to which the chemical is being applied. The maximum deductible is $5,000. Use this form if reporting a liability insurance policy; there is a separate form for reporting a surety bond.

The following described Insurance Policy has been issued and is in full force and effect as set forth below:

NAME AND ADDRESS OF INSURED bUSINESS

NAME AND ADDRESS OF LOCAL AGENT

TELEPHONE NUMbER __________________________________________________________( )

NAME OF INSURANCE COMPANY

POLICY NUMbER

LIMIT OF COVERAGE: COMPLETE A Or B
A. bODILY	PROPERTY
INjURY: $ ____________________________	DAMAGE: $__________________________

B. COMbINED SINGLE LIMIT (CSL): $ ______________________________________________

DEDUCTIbLE (MUST bE COMPLETED)

POLICY PERIOD:

FROM:TO:

EXCLUSIONS: FRIC not valid unless one of the following is checked:

No pesticides are excluded from this policy.

The following pesticides are excluded: __________________________________________________________

Only the following pesticides are covered: _______________________________________________________

List all aerial equipment covered by this Policy:
Aircraft Number: N-________________________	N- _______________________	N-_______________________
N-________________________	N- _______________________	N-_______________________

Agent Declaration

I certify that I have legal authority to act for _____________________________________________________ ; that said company is

PLACE OF EMPLOYMENT

a direct representative of the Underwriters and that said company is qualiied to do business in the state of Washington; and that the

insurance coverage is placed through a properly licensed agent in Washington.

It is agreed that the company will ile with the Department of Agriculture WITHIN TEN DAYS copies of any and all endorsements extend- ing, restricting, changing, cancelling or renewing the aforementioned coverage. Whenever requested by the Department, the company

agrees to furnish a copy of said policy and all endorsements thereon.

Authorized Agent (please print): _______________________________________________________________________________

Signature: __________________________________________________________

Date: ____________________________

NOTE: Fax, e-mail or mail the completed form to the Department of Agriculture (addresses above).

AGR FORM 702-4279 (R/11/12)

How to Edit Agr Form 702 4279 Online for Free

The AGR Form 702 4279 is mostly completed by your insurance agent or bonding company, not by you directly. Use the FormsPal editor to review the form fields and prepare any information your agent will need before they submit the certificate to the WSDA.

How to complete the AGR 702 4279

Before contacting your insurance agent or bonding company, gather the following:

Your WSDA commercial pesticide applicator license number
Your business legal name and mailing address
The name and contact information of your insurance carrier or bonding company
Your current policy number and coverage dates
Coverage limits for bodily injury and property damage

Your agent will complete the insurer sections, add policy or bond details, and send the certificate to the WSDA Pesticide Management Division. Ask them to confirm once the form has been submitted so you can track receipt before your renewal deadline.

Submitting the form

The insurance agent or bonding company sends the completed AGR Form 702 4279 directly to the WSDA Pesticide Management Division. The mailing address appears on the form itself. Contact the WSDA Pesticide Management Division before your renewal deadline to confirm current submission options, including whether fax is accepted.

File early. If the certificate arrives after your renewal date, your commercial applicator license may lapse. A lapsed license requires a new application rather than a simple renewal, which can delay your operations.

Common questions about the AGR 702 4279

Who must file the AGR Form 702 4279?

Commercial pesticide applicators licensed in Washington State must file this form. Private applicators applying pesticides only on their own property are not required to submit it. Check with the WSDA if you are unsure whether your specific license category requires a financial responsibility certificate.

What coverage minimum does Washington require?

The WSDA sets minimum liability amounts that vary by license category. Standard commercial applicators typically need at least $50,000 per occurrence. Those who perform WDO inspections during real estate transactions may need higher limits. Contact the WSDA Pesticide Management Division or your insurance agent to confirm the current minimums for your license type.

Can I use a surety bond instead of liability insurance?

Yes. Washington State accepts a surety bond that meets the required financial responsibility thresholds as an alternative to a liability insurance policy. Your bonding company will complete the relevant section of the AGR 702 4279 in place of an insurance carrier. Review the surety bond application to understand what documentation your bonding company will prepare.

What is a WDO inspection and why does it affect this form?

A wood destroying organism (WDO) inspection identifies termites, rot fungi, and other damaging organisms during property transactions. Washington State requires applicators performing complete WDO inspections to carry higher minimum coverage than standard commercial pesticide applicators. Indicate on the form whether your activities include WDO inspections so the correct coverage section is completed.

What happens if my insurance policy lapses?

If your liability insurance or surety bond lapses, you are no longer in compliance with Washington State pesticide licensing requirements. The WSDA may suspend your commercial applicator license until a new Financial Responsibility Insurance Certificate is filed. Renew your policy before it expires and ask your agent to send an updated certificate to the WSDA promptly.

How often do I need to renew this certificate?

The AGR Form 702 4279 must be renewed whenever your commercial pesticide applicator license is up for renewal. Coverage must remain continuous throughout your licensing period. Keep your policy renewal date on file and coordinate with your agent well before your license expiration to avoid a coverage gap.

Related forms for Washington pesticide applicators: the Pesticide Safety Training form documents worker safety training requirements, and the Commercial Liability Insurance Certificate is used in other regulated industries that require similar financial proof of coverage.