Form DP-44 "Proof of Financial Responsibility Certificate Using Insurance" - Arkansas

What Is Form DP-44?

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

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Arkansas Agriculture Department;
  • 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 printable version of Form DP-44 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-44 "Proof of Financial Responsibility Certificate Using Insurance" - Arkansas

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Form DP-44 (Rev. 11-19)
ARKANSAS DEPARTMENT OF AGRICULTURE
PLANT INDUSTRIES DIVISION, PESTICIDE SECTION
PROOF OF FINANCIAL RESPONSIBILITY CERTIFICATE USING INSURANCE
This is to certify that an insurance policy, which is in accordance with the insurance laws of the State of Arkansas, has been
issued to:
Firm Name ______________________________________ Address ______________________________________________
City _____________________________________ State ______________________________ Zip ____________________
Insurance Company Name ________________________________________________________________________________
Policy/Form Number ________________________ Effective Date _______________ Expiration Date _____-___________
This policy includes pesticide application coverage.
NAIC# ______________________________________
LIMITS OF LIABILITY (Applicable to pesticide coverage)
Pesticide Application Coverage $ ____________________________________ Deductible __________________________
Does this policy cover the applications of 2,4-D containing compound? Yes
No
List any pesticides not covered by this policy: ________________________________________________________________
______________________________________________________________________________________________________
Application Equipment Covered:
“N” or other
Type (Ground/Aircraft)
Model
Identification Number
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
(List additional equipment on separate sheet and attach)
List approved pilots
____________________________________________________________________________________
By signature below the named Commercial Applicator attests that the policy identified meets the liability requirements as
specified by ACA 20-20-209 (d) and the regulations promulgated pursuant thereto.
Original Signature__________________________________________ Date_________________
Return this form to:
Arkansas Department of Agriculture,
Plant Industries Division, Pesticide Section,
P.O. Box 1069, Little Rock, AR 72203
Form DP-44 (Rev. 11-19)
ARKANSAS DEPARTMENT OF AGRICULTURE
PLANT INDUSTRIES DIVISION, PESTICIDE SECTION
PROOF OF FINANCIAL RESPONSIBILITY CERTIFICATE USING INSURANCE
This is to certify that an insurance policy, which is in accordance with the insurance laws of the State of Arkansas, has been
issued to:
Firm Name ______________________________________ Address ______________________________________________
City _____________________________________ State ______________________________ Zip ____________________
Insurance Company Name ________________________________________________________________________________
Policy/Form Number ________________________ Effective Date _______________ Expiration Date _____-___________
This policy includes pesticide application coverage.
NAIC# ______________________________________
LIMITS OF LIABILITY (Applicable to pesticide coverage)
Pesticide Application Coverage $ ____________________________________ Deductible __________________________
Does this policy cover the applications of 2,4-D containing compound? Yes
No
List any pesticides not covered by this policy: ________________________________________________________________
______________________________________________________________________________________________________
Application Equipment Covered:
“N” or other
Type (Ground/Aircraft)
Model
Identification Number
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
_______________________________
______________________________
__________________________
(List additional equipment on separate sheet and attach)
List approved pilots
____________________________________________________________________________________
By signature below the named Commercial Applicator attests that the policy identified meets the liability requirements as
specified by ACA 20-20-209 (d) and the regulations promulgated pursuant thereto.
Original Signature__________________________________________ Date_________________
Return this form to:
Arkansas Department of Agriculture,
Plant Industries Division, Pesticide Section,
P.O. Box 1069, Little Rock, AR 72203