DTSC Form 8038 "Certificate of Insurance for Public Liability Coverage" - California

What Is DTSC Form 8038?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DTSC Form 8038 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download DTSC Form 8038 "Certificate of Insurance for Public Liability Coverage" - California

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California Environmental Protection Agency
Department of Toxic Substances Control
Transporter Unit
1001 I Street MS 11A, Sacramento, CA 95814
Phone: (800) 618-6942 Fax: (916) 323-3500
Certificate of Insurance for Public Liability Coverage
DTSC Form 8038 (Revision 4/2020)
Name of Insured:
Address:
Phone Number:
Certification
The authorized signature below certifies that: (a) each policy of insurance listed below has been
issued to the insured named above and is in force at this time and (b) each policy so listed provides
vehicle liability coverage for “Public Liability“ which includes Liability for “Bodily Injury”
“Property Damage” and “Environmental Restoration” pursuant to section 25169 of the
California Health and Safety Code with respect to the operation, maintenance or use by the named
insured of any vehicle for which registration or authorization to transport hazardous waste is required
by the Department of Toxic Substances Control of the State of California regardless of whether such
vehicles are specifically described in the policy.
Primary Insurance – Combined Single Limit
Insurance Policy Number:
Effective Date of Coverage:
Insurance Company Name:
Address:
Telephone Number:
This policy provides coverage for public liability including bodily injury, property damage and
environmental restoration for the amount of $
_________ in accordance with
language consistent with an MCS-90 endorsement.
California Environmental Protection Agency
Department of Toxic Substances Control
Transporter Unit
1001 I Street MS 11A, Sacramento, CA 95814
Phone: (800) 618-6942 Fax: (916) 323-3500
Certificate of Insurance for Public Liability Coverage
DTSC Form 8038 (Revision 4/2020)
Name of Insured:
Address:
Phone Number:
Certification
The authorized signature below certifies that: (a) each policy of insurance listed below has been
issued to the insured named above and is in force at this time and (b) each policy so listed provides
vehicle liability coverage for “Public Liability“ which includes Liability for “Bodily Injury”
“Property Damage” and “Environmental Restoration” pursuant to section 25169 of the
California Health and Safety Code with respect to the operation, maintenance or use by the named
insured of any vehicle for which registration or authorization to transport hazardous waste is required
by the Department of Toxic Substances Control of the State of California regardless of whether such
vehicles are specifically described in the policy.
Primary Insurance – Combined Single Limit
Insurance Policy Number:
Effective Date of Coverage:
Insurance Company Name:
Address:
Telephone Number:
This policy provides coverage for public liability including bodily injury, property damage and
environmental restoration for the amount of $
_________ in accordance with
language consistent with an MCS-90 endorsement.
Cancellation Endorsement
The authorized signature below warrants and guarantees that each insurance policy for which this
Certificate of Insurance is issued is effective until canceled or expired; and, such policy coverage
shall remain in full force and effect until the 30th day after a Notice of Cancellation in writing is given
on behalf of the Insurance Company to the Department of Toxic Substances Control. The 30-day
period is to commence from the date the Notice of Cancellation is provided to the Department of
Toxic Substances Control, Transporter Unit.
This Certificate of Insurance and any Notice of Cancellation are properly filed by mailing, postage
paid to the Department of Toxic Substances Control, Transporter Unit, 1001 I Street MS 11-A,
Sacramento, California 95814.
Authorized Signature
I hereby certify under penalty of law that: (a) all information provided is true and correct, and (b)
either the Insurance Company is admitted by the Department of Insurance in the State of California
to write the listed insurance policies OR, if not admitted, I am licensed by the California Department
of Insurance as a “Surplus Lines Broker” authorized to represent the named Insurance Company in
making this certification.
Authorized Signature (signature in contrasting color ink):
Date Signed:
Name and Title: (Please print or type):
Surplus Lines Broker Number (if applicable):
Company Name:
Signer’s Company Address:
Telephone Number:
(Definitions used in this Certificate of Insurance are shown below.)
Definitions for This Certificate of Insurance
“Admitted” means entitled to transact insurance business in California, having complied with the
laws of the State of California imposing conditions precedent to transaction of such business.
“Bodily Injury” means injury to the body, sickness, or disease to any person, including death,
resulting from any of these.
“Day” means every calendar day, excluding the first day and including the last day, unless the last
day is a Saturday, Sunday, or holiday specified by State law, and then such calendar day is also
excluded.
“Environmental Restoration” means restitution for the loss, damage, or destruction of natural
resources arising out of the accidental discharge, dispersal, release or escape into or upon the land,
atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This
shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate
damage to human health, the natural environment, fish, shellfish, and wildlife.
“Property Damage” means damage to or loss of use of tangible property.
“Public Liability” means liability for “bodily injury,” “property damage,” and “environmental
restoration.”
Excerpt Section 25169, California Health and Safety Code
Section 25169 (a) Every transporter of hazardous waste shall maintain ability to respond in
damages resulting from the operation of that business. The ability to respond in damages includes
the ability to respond to public liability, as provided in subdivision (c). For purposes of this section
only, “public liability” means liability for bodily injury, including injury to the body, sickness, or
disease to any person, and death resulting from any such injury, sickness, or disease; for property
damage, including damage to, or loss of use of, tangible property; and for environmental
restoration, including restitution for the loss, damage, or destruction of natural resources arising
out of the accidental discharge, dispersal, release, or escape into or upon the land, atmosphere,
watercourse, or body of water, or any commodity transported by a motor carrier. This liability
includes the cost of removal and the cost of necessary measures taken to minimize or mitigate
damage or potential for damage to human health, the natural environment, fish, shellfish, and
wildlife.
(c) The ability to respond to public liability means having a policy of insurance coverage
issued by an insurer or a surety bond issued by a surety, which meets both of the following
requirements:
(1) The policy or bond has the liability limits specified for carriers of hazardous wastes by the
Department of Transportation in Part 387 (commencing with section 387.1) of Subchapter B
of Chapter 111 of Title 49 of the Code of Federal Regulations, except that coverage shall be
in the amount of $1,200,000 for waste petroleum in bulk shipments, and $600,000 for
vehicles under 10,000 pounds gross vehicle weight rating.
(2) The policy’s or bond’s terms conform to Form MCS-90 or MCS-82, respectively, as
defined and set forth in sections 387.7 to 387.15, inclusive, of Title 49 of the Code of Federal
Regulations, or a written decision, order or authorization to self-insure that complies with
paragraph (3) of subsection (d) of section 387.7 of Title 49 of the Code of Federal
Regulations, adopted pursuant to section 30 of the Motor Carrier Act of 1980 (49 U.S.C.
section 10927).
(d) As proof of compliance with subdivision (a), an insurer or surety which provides the
insurance coverage or surety bond required by this section shall agree to provide the
department with proof of the transporter’s ability to respond in damages. An insurer or surety
may demonstrate the ability of the transporter to respond to public liability by submitting a
completed certificate of insurance on a from provided by the department or a Form MCS-90
or MCS-82, as specified in section 387.15 of Title 49 of the Code of Federal Regulations, to
the department.
(e) An insurer or surety who has agreed to provide the department with proof of ability to
respond in damages, as required by subdivision (d), shall also provide the department with a
written or facsimile notice within 24 hours after loss of insurance providing ability to respond
in damages, as required by subdivision (d).
(Enacted by Stats. 1979, Ch. 1097, amended by Stats. 1995, Ch. 628, Sec.4. Effective
January 1, 1996..)
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