Form DEP-6035K "Hazardous Waste Facility Liability Endorsement" - Kentucky

What Is Form DEP-6035K?

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

Form Details:

  • The latest edition provided by the Kentucky Department for Environmental Protection;
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  • Quick to customize;
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  • Fill out the form in our online filing application.

Download a printable version of Form DEP-6035K by clicking the link below or browse more documents and templates provided by the Kentucky Department for Environmental Protection.

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Download Form DEP-6035K "Hazardous Waste Facility Liability Endorsement" - Kentucky

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Hazardous Waste Facility
Liability Endorsement
1. This endorsement certifies that the policy to which the endorsement is attached provides liability insurance covering bodily
injury and property damage in connection with the insured’s obligation to demonstrate financial responsibility under 401 KAR
39:090. The coverage applies at (list EPA Identification Number, name, and address for each facility)
for ________________________________________________________________________________________________ .
(insert “sudden accidental occurrences,” “nonsudden accidental occurrences,” or “sudden and nonsudden
accidental occurrences.” If coverage is for multiple facilities and the coverage is different for different
facilities, indicate on an attached sheet which facilities are insured for sudden accidental occurrences, which
are insured for nonsudden accidental occurrences, and which are insured for both)
The limits of liability are __________________________ for each occurrence and ___________________________ annual
(insert the dollar
(insert the dollar amount
amount of the “each
of the “annual aggregate”)
occurrence”)
aggregate, exclusive of legal defense costs.
2. The insurance afforded with respect to such occurrences is subject to all of the terms and conditions of the policy;
provided, however, that any provisions of the policy inconsistent with subsections (a) through (e) of this paragraph 2 are hereby
amended to conform with subparagraphs (a) through (e):
(a) Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy to which this
endorsement is attached.
(b) The Insurer is liable for the payment of amounts within any deductible applicable to the policy, with a right of reim-
bursement by the insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of
any deductible for which coverage is demonstrated as specified in 401 KAR 39:090.
(c) Whenever requested by the Division of Waste Management, hereinafter the Division, the Insurer agrees to furnish to the
Division a signed duplicate original of the policy and all endorsements.
(d) Cancellation of this endorsement, whether by the Insurer, the insured, a parent corporation providing insurance coverage
for its subsidiary, or by a firm having an insurable interest in and obtaining liability insurance on behalf of the owner or operator of
the hazardous waste site or facility, will be effective only upon written notice and only after the expiration of sixty (60) days after
a copy of such written notice is received by the Division.
Hazardous Waste Facility
Liability Endorsement
1. This endorsement certifies that the policy to which the endorsement is attached provides liability insurance covering bodily
injury and property damage in connection with the insured’s obligation to demonstrate financial responsibility under 401 KAR
39:090. The coverage applies at (list EPA Identification Number, name, and address for each facility)
for ________________________________________________________________________________________________ .
(insert “sudden accidental occurrences,” “nonsudden accidental occurrences,” or “sudden and nonsudden
accidental occurrences.” If coverage is for multiple facilities and the coverage is different for different
facilities, indicate on an attached sheet which facilities are insured for sudden accidental occurrences, which
are insured for nonsudden accidental occurrences, and which are insured for both)
The limits of liability are __________________________ for each occurrence and ___________________________ annual
(insert the dollar
(insert the dollar amount
amount of the “each
of the “annual aggregate”)
occurrence”)
aggregate, exclusive of legal defense costs.
2. The insurance afforded with respect to such occurrences is subject to all of the terms and conditions of the policy;
provided, however, that any provisions of the policy inconsistent with subsections (a) through (e) of this paragraph 2 are hereby
amended to conform with subparagraphs (a) through (e):
(a) Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy to which this
endorsement is attached.
(b) The Insurer is liable for the payment of amounts within any deductible applicable to the policy, with a right of reim-
bursement by the insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of
any deductible for which coverage is demonstrated as specified in 401 KAR 39:090.
(c) Whenever requested by the Division of Waste Management, hereinafter the Division, the Insurer agrees to furnish to the
Division a signed duplicate original of the policy and all endorsements.
(d) Cancellation of this endorsement, whether by the Insurer, the insured, a parent corporation providing insurance coverage
for its subsidiary, or by a firm having an insurable interest in and obtaining liability insurance on behalf of the owner or operator of
the hazardous waste site or facility, will be effective only upon written notice and only after the expiration of sixty (60) days after
a copy of such written notice is received by the Division.
(e) Any other termination of this endorsement will be effective only upon written notice and only after the expiration of
thirty (30) days after a copy of such written notice is received by the Division.
Attached to and forming part of Policy No. ___________________ issued by _____________________________________ ,
(Name of Insurer)
Herein called the Insurer, of _____________________________________________________________________________
(Addres of Insurer)
to __________________________________________________ of __________________________
(Name of Insured)
(Address)
this ____________________ day of ______________________ , 20 _______. The effective date of said policy is
(Day)
(Month)
(Year)
____________________ day of _______________________ ,20_______ .
(Day)
(Month)
(Year)
I hereby certify that the wording of this endorsement is identical to the wording specified in 401 KAR 39:090 as such
regulations were constituted on the date first above written, and that the Insurer is licensed to transact the business of insurance in
the Commonwealth of Kentucky or, if exempted by KRS 304.11-030, the insurer is licensed to provide insurance as an excess or
surplus lines insurer in one (1) or more states.
(Signature of Authorized Representative of Insurer)
(Name, typed)
(Title, typed)
Authorized Representative of ____________________________________________
(Name of Insurer)
(Address of Representative, typed)
DEP-6035K, effective 2/22/18
(Note: Use of this template is required by 401 KAR 39:090.)
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