FROM

FRX NO.

6132580015

Nov. 30 2012 10:04PM

Pi

,.....

Canadian Institute for Political Integrity

"The Lighthou8e at onawa" , \IVY2E ~

Assembly of Independent Canadians (Ale) a=a<EA1IQ\I

clo Glen Kealey, Chairman, National President and Founder

November 30, 2012

With regards to volunteers pe.-sonal security and, the Canadian Insrltute for Political Integrity security recommendation - that du.e to the obvious duplicitous COnstnJ.ctiOll of this inslUanc:e questioDJlaire~ which follows on the tail of a potential FLOOD war.o.in.gmade hy them a few years ago we, CIPI, have decided henceforth to stop using heating oil as a means of generating "heat for comfort" from our basement holding tank; nnd thus, we have pcnnaneody shut down the oil fu.roa<Jeat the farm, as well as h.ave decided to leave the oil tank on its alrrcnt leveJ "EMPTY". Once, if ever, corporate integrity returns to the Ca1uldian ~Chumaa control industry" re<lO.D5idertb.is decision if ooly we can then deem it to be ethical and secure. Signed for: The Cell (CIPI SECURITY) Canadian Institute for Politicallnteuity PS Also note the planned S~ERIOR we MAY

"1..00 at the Soo~ heading for Waterloo, Ontario, Canada

YORK".

and tLe enti.-e Brv.ce Peninsula on its way to "FLUSHINC NEW' '" Inspe<:tion

by Insurers alluwed with appointment

FROM :

FAX NO. : 6132580015

Nov. 30 2012 10:04PM

P2

du-plic-i-tous (doo-plIs/l-tas, dyoo-) adj. Given to or marked by deliberate deceptiveness in behavior or speech. =du-ptlcq-tous-ly adv. -du-pllc'l-tous-ness n.

".'.

FROM

FAX NO. : 6132580015

Dec. 01 2012 03:00AM

P1

~ Gk'?-

~\1VL:'

~h\~ltW~ (I. ,~\

~~,;V,20\1,
(-<\\ot

<Q.<i-L L\'~
~()

lfz.i-C-\<1.-"'" ~~

<~-,.<:-,.5'~\"'C'-(

e.:u.)

LANARK MUTUAL INSURANCE

1. H8.3a qualified, Oil Burnet Techniciaa, 2. Tank Manufacturer: Location of tank: 3, Tank ~e: clnside

Frl
_

Oil Supplier deemed an immediate hazard'! Year tank ~ IDlilltlfactured: ~

oYes

oNo _

oOut~dc: aStee! (14 gauge-2mm)' _

If inside - where?

------------------------oDoublc-walled T05umppumPQr~~ oYes OYC3

aYes

QSteel (12 gauge-2.S=) Distances: To walls:

oFibreglass oS.lngle walled _

Other:

'--oNo oNe aNo oNo aNo

4. If tank is inside:

To fuel fired appliances:

5. I~ tank located in.or under tb.e ground (excluding basement)? 6. Does the supply line (from the rank to the appliance) pass through any concrete floor or wall? 7. Is fuel delivered by anyone other than a qualified Fuel Oil Supplier? 8. Is tank installed on anything other than a solid concrete slab? 9. AIe there any current/ongeiag Details: 11. Have there been any previous 011spills involving yaw property? Derails: If possible, attach II-copy of a "Record of Sire Condition" dOClllllent. 12. If the oil taok ;!: located outside oftbe main dwelling, is protection from ice and vehicle impact missing? oN! A 13. Is the tank filter located outaide !he dwellg?
D Unknown

DYes DYes

spills invoJviJJg your property?

0 Y es

DNa

oYes

oNe
aNe oNo

aYes
eYes _ o Unknown Fill Pipes: age: __ Filter Body: 118":__ DYes eYes

14. Was the oil tank ~4!d Name oflnstaller:

by anyone other than a qualified Oil BlIlII~ Technician?

----

15, Is any oflbe following older than the oil~? Supply Lines: age:__ Vents: ageJ__

oNo

16. Are there unused. fuel oil tanks on the property? 17. Do you have an annual ccaintenance service contract with an Oil BumerTechnician?

oNo aNa

oYes

N~~ __ ~----~

(please attach a copy of the co net orpfoofofmaiv.Wlla/lce.)

aNa
a Un,knQWD

__ -~~--~--~~-~----~_

18. Is the tank labelled CSNULC certified? 19. Is tank new and not previously used? 20. Is th~ a h.orizontalloop
ill

DYes DYes

oNo
oNo
oNo

the line xtthe tank and appliance?

UQIIl

21. Are fill and vent pipes constructed

black piJx;?

o Unknown

o Yes

FRX NO. FROM

6132580015

Dec. 01 2012 03:01AM

P2

22. ~

filters

ute

approved?

aYes
oo:s
ot!S

aNo oNo

23. Have flared fittillgs been used on all feed lines, filters sad fittings?

oNo
eNo

25. Is ta.nkI~pment

rust free?

oYe:,

This questionnaire is completed to the

Signature ofappUcantf'wsured: ~~ ~

h\r ofmy

ability IZnd knfIWiedge

{~t~9
eYes
Date: _ oNo

This questionnaire is completed to the best of my ability and klzuwledge

Coverage bound?

Signature of Agent/Broker:

1111

i 1IIIIIt

1/1/11111111111111111111111111111111111111111111111111III

'III"

1'1111'

11'1111'11'11111'

Office use only;

\

OBT Inspection received? Supplemental Photos Questionnaao

\ fuUy completed andlsigned?

oYes aYes aYes

aNa oNo oNo

. reeClved?

II
\

Signature of Uaderwrirer approval:

-L.I
r\ ~

Date:

_
_

Und~gA~oD~:

I
\

I ,
f ,,":art,. lA .... '
1 .. __ . ' -