DEP Form 62-730.900(4)(P) "Hazardous Waste Facility Surety Bond to Demonstrate Liability Coverage" - Florida

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

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)(P) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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DEP Form # 62-730.900(4)(p)
Form Title: HWF Liability Surety Bond
Effective Date: 1-29-06
DEP Application #
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY SURETY BOND
TO DEMONSTRATE LIABILITY COVERAGE
Surety Bond # ____________________
Parties _______________________________________________________________, Principal,
[Name and Address of the Owner or Operator]
incorporated in _________________________ of __________________________________ and
[State of Incorporation]
[City and State of Principal Place of Business]
_________________________________________________________________________________________________________________ ,
[Name and Address of Surety Company(ies)]
_________________________________________________________________________________________________________________ ,
_________________________________________________________________________________________________________________ ,
Surety Company(ies) of __________________________________________________________
[Surety’s(ies’) Place of Business]
__________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________ .
List the EPA identification number, name and address of each facility guaranteed by this bond:
_________________________________________________________________
Sudden
Nonsudden
Accidental
Accidental
Occurrences
Occurrences
____________________________________________________________________________________________
Penal Sum Per Occurrence
$____________________________
$_____________________________
Annual Aggregate
$____________________________
$_____________________________
Page 1 of 5
DEP FORM 62-730.900(4)(p) effective 1-29-06
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PRINT
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DEP Form # 62-730.900(4)(p)
Form Title: HWF Liability Surety Bond
Effective Date: 1-29-06
DEP Application #
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY SURETY BOND
TO DEMONSTRATE LIABILITY COVERAGE
Surety Bond # ____________________
Parties _______________________________________________________________, Principal,
[Name and Address of the Owner or Operator]
incorporated in _________________________ of __________________________________ and
[State of Incorporation]
[City and State of Principal Place of Business]
_________________________________________________________________________________________________________________ ,
[Name and Address of Surety Company(ies)]
_________________________________________________________________________________________________________________ ,
_________________________________________________________________________________________________________________ ,
Surety Company(ies) of __________________________________________________________
[Surety’s(ies’) Place of Business]
__________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________ .
List the EPA identification number, name and address of each facility guaranteed by this bond:
_________________________________________________________________
Sudden
Nonsudden
Accidental
Accidental
Occurrences
Occurrences
____________________________________________________________________________________________
Penal Sum Per Occurrence
$____________________________
$_____________________________
Annual Aggregate
$____________________________
$_____________________________
Page 1 of 5
DEP FORM 62-730.900(4)(p) effective 1-29-06
____________________________________________________________________________________________
Purpose: This is an agreement between the Surety(ies) and the Principal under which the
Surety(ies), its(their) successors and assignees, agree to be responsible for the payment of claims
against the Principal for bodily injury and / or property damage to third parties caused by
__________________________ accidental occurrences arising from operations of the facility or
["sudden" and/or "nonsudden"]
group of facilities in the sums prescribed herein; subject to the governing provisions and the
following conditions.
Governing Provisions:
(1) Section 3004 of the Resource Conservation and Recovery Act of 1976, as amended.
(2) Rules and regulations of the U.S. Environmental Protection Agency (EPA), particularly 40
CFR Part 264.147 or 265.147.
(3) Rules and regulations of the Florida Department of Environmental Protection (FDEP),
particularly Chapter 62-730 of the Florida Administrative Code (F.A.C.).
Conditions:
(1) The Principal is subject to the applicable governing provisions that require the Principal to
have and maintain liability coverage for bodily injury and property damage to third parties
caused by __________________________ accidental occurrences arising from operations
["sudden" and/or "nonsudden"]
of the facility or group of facilities. Such obligation does not apply to any of the following:
(a) Bodily injury or property damage for which _______________________________________
[Principal]
is 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
___________________would be obligated to pay in the absence of the contract or
agreement.
[Principal]
(b) Any obligation of ___________________________________________ under a workers'
[Principal]
compensation, disability benefits or unemployment compensation law or similar law.
(c) Bodily injury to:
(i) An employee of _______________________________________________ arising from, and
[Principal]
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).
Page 2 of 5
DEP FORM 62-730.900(4)(p) effective 1-29-06
(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.
(2) This bond assures that the Principal will satisfy valid third party liability claims, as described
in condition 1.
(3) If the Principal fails to satisfy a valid third party liability claim, as described above, the
Surety(ies) becomes liable on this bond obligation.
(4) The Surety(ies) shall satisfy a third party liability claim only upon the receipt of one of the
following documents:
(a) Certification from the Principal and the third party claimant(s) that the liability claim should
be paid. The certification must be worded as follows:
Certification of Valid Claim
The undersigned, as parties ____________________________________________________ and
[Principal]
______________________________________________________________________________
[Name and Address of Third Party Claimant(s)]
______________________________________________________________________________
hereby certify that the claim of bodily injury and/or property damage caused by
a_____________
[sudden or nonsudden]
accidental occurrence arising from operating _________________________________________
[Principal's]
hazardous waste treatment, storage or disposal facility should be paid in the amount of
$ _____________________________________.
__________________________________________________
__________________
[Signature of the Principal]
[Date]
__________________________________________________
__________________
[Signature of the Notary]
[Date]
__________________________________________________
__________________
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DEP FORM 62-730.900(4)(p) effective 1-29-06
[Signature(s) of the Claimant(s)]
[ Date]
__________________________________________________
__________________
[Signature of the Notary]
[Date]
or
(b) A valid final court order establishing a judgment against the Principal for bodily injury or
property damage caused by sudden or nonsudden accidental occurrences arising from the
operation of the Principal's facility or group of facilities.
(5) In the event of combination of this bond with another mechanism for liability coverage, this
bond will be considered _________________ coverage.
[insert "primary" or "excess"]
(6) The liability of the Surety(ies) shall not be discharged by any payment or succession of
payments hereunder, unless and until such payment or payments shall amount in the
aggregate to the penal sum of the bond. In no event shall the obligation of the Surety(ies)
hereunder exceed the amount of said annual aggregate penal sum, provided that the
Surety(ies) furnish(es) notice to the FDEP Secretary forthwith of all claims filed and
payments made by the Surety(ies) under this bond.
(7) The Surety(ies) may cancel the bond by sending notice of cancellation by certified mail to
the Principal and the FDEP Secretary, provided, however, that cancellation shall not occur
during the 120 days beginning on the date of receipt of the notice of cancellation by the
Principal and the FDEP Secretary, as evidenced by the return receipt.
(8) The Principal may terminate this bond by sending written notice to the Surety(ies) and to
the FDEP Secretary.
(9) The Surety(ies) hereby waive(s) notification of amendments to applicable laws, statutes,
rules and regulations and agree(s) that no such amendment shall in any way alleviate its
(their) obligation on this bond.
(10) This bond is effective from________________ (12:01 a.m., standard time, at the address of
[Date]
the Principal as stated herein) and shall continue in force until terminated as described
above.
In Witness Whereof, the Principal and Surety(ies) have executed this Bond and have affixed
their seals on the date set forth above. The persons whose signatures appear below hereby certify
that they are authorized to execute this surety bond on behalf of the Principal and Surety(ies) and
that the wording of this surety bond is substantially identical to the wording specified in 40 CFR
264.151(1), as such regulations were constituted on the date this bond was executed.
PRINCIPAL
CORPORATE SURETY(IES)
For each co-surety provide the following:
______________________________________
__________________________________
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DEP FORM 62-730.900(4)(p) effective 1-29-06
[Signature(s)]
[Name and Address]
______________________________________
__________________________________
[Type Name(s) & Title(s)]
_____________________
State of Incorporation:
Corporate Seal
Not Applicable
________________________
Liability Limit: $
__________________________________
[Signature(s)]
Bond Premium:$____________________
____________________________
[Name(s) & Title(s)]
Corporate seal
Page 5 of 5
DEP FORM 62-730.900(4)(p) effective 1-29-06
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