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.� State of California <br />For Stat Use Only <br />"._ State Water Resources Control Board <br />} <br />Division of Financial Assistance <br />P.O. Box 944212 <br />+� a <br />Sacramento, CA 94244-2120 <br />CERTIFICATION OF FINANCIAL RESPONSIBILITY <br />FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM <br />A. I an regured todemavuae Fh,anaal Respombd in the repvad aN o—m as apenRed in CCA, Time 21 Dmwa 3, ChWkx 13, Seatiue 2607 <br />❑ 500,000 dollars per occurrence ❑ 1 million dollars annual aggregate <br />or AND or <br />® I million dollars per occurrence ® 2 million dollars annual aggregate <br />B Ryder Systems, Inc. and its associated, affiliated or hereby certifies that it is in compliance with the requirements of <br />Subsidiary Companies as are now, or may hereafter be California Code of Regulations. Title 23. Division 3, Chapter 18, Article <br />constituted 3, Section 2807, <br />The mechanisms used to dernonstrate financial sponsibilitvas required by Section 2807 are as follows: <br />C. Mecltanistn <br />Name and Address of Issuer <br />Mechanism <br />Coverage <br />Coverage <br />Corrective <br />Third Party. <br />Type <br />Number <br />Amount <br />Period <br />Action <br />Compensation <br />State UST Cleanup Fund <br />State UST <br />PO Box 944212 <br />N/A for <br />Fund <br />Sacramento, CA 94244- <br />Cleanup <br />5990,000.00 <br />State List <br />Yes <br />Yes <br />2120 <br />Old Republic Insurance <br />Commerical <br />133 Oakland Ave <br />10/01/12 <br />Insurance <br />PO Boz 2200 <br />Z-35725 <br />510,000.00 <br />10/01/13 <br />Yes <br />Yes <br />Greensburg, PA 15601 <br />Note: If you arc using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also <br />certifies that you arc in compliance and shall remain in compliance with Al conditions for panicipation in the Fund. <br />D. F.A. K_ <br />Facility Add— <br />See attached list <br />F,d,y Na: <br />F.oaf Addax <br />F.&O Naa <br />F—Any A M— <br />Ffrin N: <br />F—hl, Adder <br />T�'dn Nam <br />F,ey, Ayy- <br />Ftyn Nr <br />Fr+In Aedre. <br />f.aq Nwr <br />Fawy Aedes <br />Dar <br />N— wd Tak ofTC.—ri p.a Q,. <br />E <br />9!26/2012 <br />Amy White - Owner's Authorized Rep <br />Dr <br />erns d W_ of M.0 <br />9/2612012 <br />Everett Simmons <br />�i ti Submit original to local UST regulatory agency. Keep a copy at each UST facility. <br />3t. fl nre3—CA _ 2012.doc www.unido<i.org Rev. 10/16/06 <br />