AGR-4279: Washington Commercial Pesticide Applicators Financial Responsibility Insurance Certificate

Enter the Name and Address of Insured Business.

Enter the Name and Address of Local Agent and the Telephone Number.

Enter the Name of Insurance Company and the Policy Number of the Insurance Policy that has been issued and is in full force and effect.

Under Limit of Coverage, complete A or B; for A, enter the Bodily Injury and Property Damage limits.

If you complete B, enter the Combined Single Limit (CSL).

Deductible must be completed.

Enter the Policy Period, From and To.

The FRIC is not valid unless one of these is checked: No pesticides are excluded from this policy; The following pesticides are excluded; Only the following pesticides are covered. List the excluded pesticides or the covered pesticides on the line next to the box you check.

List all aerial equipment covered by this Policy, by Aircraft or Drone Number.

The agent certifies legal authority to act for the place of employment entered on the form, that said company is a direct representative of the Underwriters and qualified to do business in the state of Washington, and that the insurance coverage is placed through a properly licensed agent in Washington.

The company agrees to file with the Department of Agriculture WITHIN TEN DAYS copies of any and all endorsements extending, restricting, changing, cancelling or renewing the aforementioned coverage.

Washington pesticide law (chapter 17.21 RCW) requires that all Commercial Applicators submit proof of financial responsibility. Commercial 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 (checked November 8, 2026). This includes loss of damage arising out of the actual use of any pesticide not excluded on the form, including chemical drift damage onto property other than the property to which the chemical is being applied. The maximum deductible is $5,000 (checked November 8, 2026). Use this form if reporting a liability insurance policy; there is a separate form for reporting a surety bond.

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.

A Commercial Applicator who applies pesticides and conducts complete WDO inspections must meet the financial coverage requirements of both the Commercial Applicator and the Structural Pest Inspector license.