COMPLIANCE INFO_2004-2009 - Laserfiche WebLink

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s r '��r_� �'� .,°- ��"^.;a,: w.�. �p ,,;..Fir�.��, s ?�, q�, ,�,".,✓`,.. ,^�C-��, �� ..� . ,,;a.,�� a cx�',.; �?,_ Name:[name of each covered 1peation] made by the["Insurer"or"Group'l. This provision does not Address: [address of each covered Dation] apply with respect to that amount of any deductible for which , coverage is demonstrated under another mechanism or Policy Number combination of mechanisms as specified in 40 CFR 280.95- Period of Coverage [current policy period]: 280.102. Name of[Insurer or Risk Retention Group]: c. Whenever requested by[a Director of an Implementing Address of[Insurer or Risk Retention Group]: Agency],the["Insurer"or"Group's agrees to furnish to[the Name of Insured: Director]a signed duplicate original of the policy and all endorsements. Address of Insured: 1. This endorsement certifies that the policy to which the d. Cancellation or any other termination of the insurance by endorsement is attached provides liability insurance covering the 'Insurer«or"Group'],except for non-payment of premium the following underground storage tank(s): or misrepresentation by the insured,will be effective only upon written notice and only after the expiration of 60 days after a ' [List the number of tanks at each facility and the name(s)and copy of such written notice is received by the insured. address(es)of the facility(ies)where the tanks are located. If Cancellation for non-payment of premium or more than one instrument is used to assure different tanks at misrepresentation by the insured will be effective only upon any one facility,for each tank covered by this instrument,list written notice and only after expiration of a minimum of 10 the tank identification number provided in the notification days after a copy of such written notice is received by the ` submitted pursuant to 40 CFR 280.22,or the corresponding insured. state requirement,and the name and address of the facility.] [Insert for claims-made policies: for[insert:"taking corrective action"and/or"compensating e. The insurance covers claims otherwise covered by the third parties for bodily injury and property damage caused by" either"sudden accidental releases"or"nonsudden accidental moat that are reported to the["Insurer"ll"Groupwithin six " • months of the effective date of the cancellation or non-renewal releases"or"accidental release";in accordance with and subject to limits of liability,exclusions,conditions,and other of the policy except where the new or renewed policy has the terms of the policy;if coverage is different for different tanks or some retroactive date ora retroactive date earlier than that of locations,indicate the type of coverage applicable to each the policy, and which arise out of any covered u tank or location]arising from operating the underground occurrence that commenced after the policy retroactive date,if storage tank(s)identified above. applicable,and prior to such policy renewal or termination date. Claims reported during such extended reporting period The limits of liability are[insert the dollar amount of the"per are subject to the terms,conditions,limits,including limits of occurrence"and"annual aggregate"limits of the Insurer's or liability,and exclusions of the policy.] " Group's liability;if the amount of coverage is different for I hereby certify that the wording of this instrument is identical different types of coverage or for different underground to storage tanks or locations,indicate the amount of coverage for or wording in 40 CFR 28ansac the and that the nInsurer" each type of coverage and/or for each underground storage or"Grible to ["licensed to transact the business of insurance tank or location],exclusive of legal defense costs,which are or eligible to provide insurance as an excess or surplus lines subject to a separate limit under the policy. This coverage is insurer in are or more states".) provided under[policy number]. The effective date of said policy is[date] [Signature of authorized representative of Insurer or Risk Retention Group] O 2. The insurance afforded with respect to such occurrences is subject to all of the terms and conditions of the policy; (Printed came of person signing] provided,however,that any provisions inconsistent with [f-itle of person signing],Authorized Representative of[name subsections(a)through(e)of this Paragraph 2 are hereby amended to conform with subsection(a)through(e): of Insurer of Risk Retention Group] a. Bankruptcy or insolvency of the insured shall not relieve [Address of Representative] the["Insurer"o"Group's of its obligations under the policy to which this endorsement is attached. b. The["Insurer"or"Group"]is liable for the payment of 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 Dollars And Sense 10 47