DEP Form 62-730.900(4)(O) "Hazardous Waste Facility Irrevocable Letter of Credit to Demonstrate Liability Coverage" - Florida

What Is DEP Form 62-730.900(4)(O)?

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

Form Details:

  • Released on January 29, 2006;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • 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 DEP Form 62-730.900(4)(O) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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Download DEP Form 62-730.900(4)(O) "Hazardous Waste Facility Irrevocable Letter of Credit to Demonstrate Liability Coverage" - Florida

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DEP Form # 62-730.900(4)(o)
Form Title: HWF Liability Letter of Credit
Effective Date: 1-29-06
DEP Application #
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY
IRREVOCABLE LETTER OF CREDIT
TO DEMONSTRATE LIABILITY COVERAGE
Florida Department of Environmental Protection
Hazardous Waste Regulation Section
_______________________________________
Financial Assurance
[Name of Issuing Institution]
2600 Blair Stone Road MS # 4560
_______________________________________
Tallahassee, Florida 32399-2400
[Address of Issuing Institution]
Dear Sir or Madam:
We hereby establish our Irrevocable Standby Letter of Credit # ______________________
in the favor of any and all third-party liability claimants, at the request and for the account of
______________________________________________________________________________
[Owner’s or Operator’s Name and Address]
______________________________________________________________________________
for third-party liability awards or settlements up to _____________ US dollars $
_____________
[in Words]
[in Numbers]
per occurrence and the annual aggregate amount of ____________ US dollars $ _____________
[in Words]
[in Numbers]
for sudden accidental occurrences, and / or for third-party liability awards or settlements up to
__________________US dollars $ ________________ per occurrence and the annual aggregate
[in Words]
[in Numbers]
amount of ___________________US dollars $ ___________________ for nonsudden accidental
[in Words]
[in Numbers]
occurrences available upon presentation of a sight draft bearing reference to this letter of credit,
and:
(1) a signed certificate reading as follows:
Certificate of Valid Claim
The undersigned, as parties ____________________________________________________
[Principal]
and __________________________________________________________________________
[Name and Address of Third Party Claimant(s)]
__________________________________________________________________________________________________________________
hereby certify that
the claim of bodily injury and / or property damage caused by
a
__________________________________ accidental occurrence arising from the operations of
[insert “sudden” or “nonsudden”]
______________________________________________________________________________
[Principal’s]
Page 1 of 3
DEP FORM 62-730.900(4)(o) effective 1-29-06
SAVE
PRINT
CLEAR
DEP Form # 62-730.900(4)(o)
Form Title: HWF Liability Letter of Credit
Effective Date: 1-29-06
DEP Application #
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY
IRREVOCABLE LETTER OF CREDIT
TO DEMONSTRATE LIABILITY COVERAGE
Florida Department of Environmental Protection
Hazardous Waste Regulation Section
_______________________________________
Financial Assurance
[Name of Issuing Institution]
2600 Blair Stone Road MS # 4560
_______________________________________
Tallahassee, Florida 32399-2400
[Address of Issuing Institution]
Dear Sir or Madam:
We hereby establish our Irrevocable Standby Letter of Credit # ______________________
in the favor of any and all third-party liability claimants, at the request and for the account of
______________________________________________________________________________
[Owner’s or Operator’s Name and Address]
______________________________________________________________________________
for third-party liability awards or settlements up to _____________ US dollars $
_____________
[in Words]
[in Numbers]
per occurrence and the annual aggregate amount of ____________ US dollars $ _____________
[in Words]
[in Numbers]
for sudden accidental occurrences, and / or for third-party liability awards or settlements up to
__________________US dollars $ ________________ per occurrence and the annual aggregate
[in Words]
[in Numbers]
amount of ___________________US dollars $ ___________________ for nonsudden accidental
[in Words]
[in Numbers]
occurrences available upon presentation of a sight draft bearing reference to this letter of credit,
and:
(1) a signed certificate reading as follows:
Certificate of Valid Claim
The undersigned, as parties ____________________________________________________
[Principal]
and __________________________________________________________________________
[Name and Address of Third Party Claimant(s)]
__________________________________________________________________________________________________________________
hereby certify that
the claim of bodily injury and / or property damage caused by
a
__________________________________ accidental occurrence arising from the operations of
[insert “sudden” or “nonsudden”]
______________________________________________________________________________
[Principal’s]
Page 1 of 3
DEP FORM 62-730.900(4)(o) effective 1-29-06
hazardous waste treatment, storage or disposal facility should be paid in the amount of
$ _________________. We hereby certify that the claim does not apply to any of the following:
(a) Bodily injury or property damage for which _____________________________________is
[Principal]
obligated to pay damages by reason of the assumption of liability in a contract or
agreement.
This
exclusion
does
not
apply
to
liability
for
damages
that
___________________________
[Principal]
would be obligated to pay in the absence of the contract or agreement.
(b) Any obligation of ____________________________________________ under a workers’
[Principal]
compensation, disability benefits or unemployment compensation law or any similar law.
(c) Bodily injury to:
(i) An employee of ____________________________________________ arising from,
[Principal]
and in the course of, employment by _____________________________________; or
[Principal]
(ii) The spouse, child, parent, brother or sister of that employee as a consequence of, or
arising from, and in the course of employment by ____________________________.
[Principal]
This exclusion applies:
(A) Whether_________________________________________________________
[Principal]
may be liable as an employer or in any other capacity; and
(B) To any obligation to share damages with or repay another person who must pay
damages because of the injury to persons identified in paragraphs (i) and (ii).
(d) Bodily injury or property damage arising out of the ownership, maintenance, use or
entrustment to others of any aircraft, motor vehicle or watercraft.
(e) Property damage to:
(i) Any property owned, rented or occupied by ___________________________________;
[Principal]
(ii) Premises that are sold, given away or abandoned by _____________________________
[Principal]
if the property damage arises out of any part of those premises;
(iii) Property loaned to _______________________________________________________;
[Principal]
(iv) Personal property in the care, custody or control of _____________________________;
[Principal]
(v) That particular part of real property on which __________________________________
[Principal]
or any contractors or subcontractors working directly or indirectly on behalf of
_______________________________________________________________________
[Principal]
are performing operations, if the property damage arises out of these operations.
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DEP FORM 62-730.900(4)(o) effective 1-29-06
_____________________________________________________________________________
[Claimant(s)]
_____________________________________________________________________________
[Grantor]
Or
(2) a valid final court order establishing a judgment against the Grantor for bodily injury or
property damage caused by sudden or nonsudden accidental occurrences arising from the
operation of the Grantor’s facility or group of facilities.
This letter of credit is effective as of ____________ and shall expire on_________________
[Date]
[Date at least one year later]
but such expiration date shall be automatically extended for a period of ____________________
[at least one year]
on _______________ and on each successive expiration date, unless, at least 120 days before the
[Same Date as “Date at least one year later”]
current expiration date, we notify you, the Florida Department of Environmental Protection and
_______________________________________________________________ by certified mail
[Owner’s or Operator’s Name]
that we have decided not to extend this letter of credit beyond its current expiration date.
Whenever this letter of credit is drawn on under and in compliance with the terms of this
credit, we shall duly honor such draft upon presentation to us.
In the event that this letter of credit is used in combination with another mechanism for
liability coverage, this letter of credit shall be considered ________________________
coverage.
[insert “primary” or “excess”]
We certify that the wording of this letter of credit is substantially identical to the wording
specified in 40 CFR 264.151(k) as such regulations were constituted on the date shown
immediately below.
__________________________________________________
_____________________
[Signature and Title of Official of Issuing Institution]
[Date]
__________________________________________________
_____________________
[Signature and Title of Official of Issuing Institution]
[Date]
This credit is subject to _______________________________________________________
_____________________________________________________________________________.
[insert “the most recent edition of the Uniform Customs and Practice for Documentary Credits, published and copyrighted by the International
Chamber of Commerce” or “the Uniform Commercial Code”]
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DEP FORM 62-730.900(4)(o) effective 1-29-06
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