COMPLIANCE INFO_2004-2009 - Laserfiche WebLink

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4 10) Name:[name of each covered location] coverage is demonstrated under another mechanism or Address: [address of each covered location] combination of mechanisms as specified in 40 CFR 280.95- Policy Number 280.102. Period of Coverage [current policy period]: c. Whenever requested by[a Director of an Implementing Agency],the["Insurer"or"Group'/agrees to furnish to[the Name of[Insurer or Risk Retention Group]: Director]a signed duplicate original of the policy and all Address of[Insurer or Risk Retention Group]: endorsements. Name of Insured: d. Cancellation or any other termination of the insurance by Address of Insured: the Insurer"or"Grow ' [" p"],except for non-payment of premium 1. [Name of Insurer or Risk Retention Group],[the"Insurer"or or misrepresentationof insured,will be effective only upon "Group's,as identified above,hereby certifies that it has issued written notice and only after the expiration of 60 days after a liability insurance covering the following underground storage copy of such written notice is received by the insured. tank(s): Cancellation for non-renewal of premium or misrepresentation by the insured will be effective only upon [List the number of tanks at each facility and the name(s)and written notice and only after expiration of a minimum of 10 address(es)of the facility(ies)where the tanks are located. If days after a copy of such written notice is received by the more than one instrument is used to assure different tanks at insured. any one facility,for each Jank covered by this instrument,list the tank identification number provided in the notification [Insert for claims-made policies: submitted pursuant to 40 CFR 280.22,or the corresponding state requirement,and the name and address of the facility.] e. The insurance covers claims otherwise covered by the policy that are reported to the["insurer"or"Group'/within six for[insert:"taking corrective action"and/or"compensating months of the effective date of cancellation or non-renewal of third parties for bodily injury and property damage caused by" the policy except where the new or renewed policy has the either"sudden accidental releases"or"nonsudden accidental same retroactive date or a retroactive date earlier than that of releases"or"accidental releases";in accordance with and the prior policy,and which arises out of any covered subject to the limits of liability;exclusions,conditions,and other occurrence that commenced after the policy retroactive date,if terms of the policy;if coverage is different for differenttanks or applicable,and prior to such policy renewal or termination locations,indicate the type of coverage applicable to each date. Claims reported during such extended reporting periods tank or location]arising from operating the underground are subject to the terms,conditions,limits,including limits of storage tank(s)identified above. liability,and exclusions of the policy.] The limits of liabilityare[insert the dollar amount of the"per I hereby certify that the wording of this instrument is identical occurrence"and"annual aggregate"limits of the Insurer's or to the wording in 40 CFR 280.97(b)(1)and that the["Insurer" Group's liability;if the amount of coverage is different for or"Group's is["licensed to transact the business of insurance different types of coverage or for different underground or eligible to provide insurance as an excess or surplus lines storage tanks or locations,indicate the amount of coverage for insurer in one or more states".] each type of coverage and/or for each underground storage tank or location],exclusive of legal defense casts,which are [Signature of authorized representative of Insurer or Risk subject to a separate limit under the policy. This coverage is Retention Group] provided under[policy number]. The effective date of said policy is[date]. [Printed name of person signing] 2. The["Insurer"or"Group's further certifies the following with [Tide of person signing],Authorized Representative of[name respect to the insurance described in Paragraph 1: of Insurer or Risk Retention Group] a. Bankruptcyor insolvencyof the insured shall not relieve [Address of Representative] the["Insurer"or"Group's of its obligations under the policy to which this certificate applies. b. The 'Insurer"or"Group's is liable for the payment of �f amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third party,with a right of reimbursement by the insured for any such payment made by the["Insurer"or"Group'. This provision does not apply with respect to that amount of any deductible for which Dollars And Sense 99