DEP Form 62-761.900(3) Part B "Storage Tank Guarantee" - Florida

What Is DEP Form 62-761.900(3) Part B?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida.The document is a supplement to DEP Form 62-761.900(3), Storage Tank Certificate of Insurance. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • 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 62-761.900(3) Part B 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 62-761.900(3) Part B "Storage Tank Guarantee" - Florida

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SAVE
PRINT
CLEAR
A copy of financial instruments kept off-site shall be made
DEP Form 62-761.900(3) Part B
available for inspection upon five business days notice.
Form Title: Financial Mechanisms for Storage Tanks
Part B: ST Guarantee
Form Effective Date October 2019
Incorporated in Rules 62-761.420 and 62-762.421, F.A.C.
STATE OF FLORIDA
STORAGE TANK GUARANTEE
Reference: 40 CFR 280.96(c)
Sunbiz
Guarantee made this
by
,
[Date]
[Name of guaranteeing entity]
a business entity organized under the laws of the State of
, herein referred to as guarantor,
[Name of state]
to the Florida Department of Environmental Protection (FDEP) and to any and all third parties and obligees, on behalf of
, herein referred to as “owner or operator”,
[Name of owner or operator]
of
.
[Business address of owner or operator]
Recitals.
(1) Guarantor meets or exceeds the financial test criteria of 40 CFR 280.95 (b) or (c) and (d) and agrees to comply with
the requirements for guarantors as specified in 40 CFR 280.96(b).
(2) The owner or operator owns or operates the following storage tank(s) covered by this guarantee:
[List information for each facility. See Instruction #6 on page i for details. Indicate “See attachment” if required.]
FDEP FacID
Facility Name and Site Address
Number of Tanks
(for sites in Florida)
(for all sites covered)
or Tank I.D. Nos.
Part B page 1 of 3
DEP Form 62-761.900(3)
Entire form page 5 of 42
SAVE
PRINT
CLEAR
A copy of financial instruments kept off-site shall be made
DEP Form 62-761.900(3) Part B
available for inspection upon five business days notice.
Form Title: Financial Mechanisms for Storage Tanks
Part B: ST Guarantee
Form Effective Date October 2019
Incorporated in Rules 62-761.420 and 62-762.421, F.A.C.
STATE OF FLORIDA
STORAGE TANK GUARANTEE
Reference: 40 CFR 280.96(c)
Sunbiz
Guarantee made this
by
,
[Date]
[Name of guaranteeing entity]
a business entity organized under the laws of the State of
, herein referred to as guarantor,
[Name of state]
to the Florida Department of Environmental Protection (FDEP) and to any and all third parties and obligees, on behalf of
, herein referred to as “owner or operator”,
[Name of owner or operator]
of
.
[Business address of owner or operator]
Recitals.
(1) Guarantor meets or exceeds the financial test criteria of 40 CFR 280.95 (b) or (c) and (d) and agrees to comply with
the requirements for guarantors as specified in 40 CFR 280.96(b).
(2) The owner or operator owns or operates the following storage tank(s) covered by this guarantee:
[List information for each facility. See Instruction #6 on page i for details. Indicate “See attachment” if required.]
FDEP FacID
Facility Name and Site Address
Number of Tanks
(for sites in Florida)
(for all sites covered)
or Tank I.D. Nos.
Part B page 1 of 3
DEP Form 62-761.900(3)
Entire form page 5 of 42
This guarantee satisfies 40 CFR Part 280, Subpart H requirements for assuring funding for
[Insert “taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by"]
arising from operating the above identified storage
[Insert “accidental discharges” or “sudden accidental discharges” or “nonsudden
accidental discharges” or leave blank if only corrective action is covered]
tank(s) in the amount of:
Per Occurrence: $
Annual Aggregate: $
(3)
, guarantor guarantees to the FDEP and to any and all
[Insert appropriate phrase from the following:
"On behalf of our subsidiary, the owner or operator" (if guarantor is corporate parent of the owner or operator); or
"On behalf of our affiliate, the owner or operator" (if guarantor is a related firm of the owner or operator); or
"Incident to our business relationship with the owner or operator" (if guarantor is providing
the guarantee as an incident to a substantial business relationship with owner or operator)]
third parties that:
In the event that the owner or operator fails to provide alternate coverage within 60 days after receipt of a notice
of cancellation of this guarantee and the FDEP Secretary or the Secretary's designee ("designee") has determined or
suspects that a discharge has occurred at a storage tank covered by this guarantee, the guarantor, upon instructions from
the FDEP Secretary or designee shall fund a standby trust fund in accordance with the provisions of 40 CFR 280.112, in
an amount not to exceed the coverage limits specified above.
In the event that the FDEP Secretary or designee determines that the owner or operator failed to perform
corrective action (if covered) for discharges arising out of the operation of the above identified tank(s) in accordance with
the requirements of 40 CFR Part 280 Subpart F, the guarantor, upon written instructions from the FDEP Secretary or
designee shall fund a standby trust in accordance with the provisions of 40 CFR 280.112, in an amount not to exceed the
coverage limits specified above.
If the owner or operator fails to satisfy a judgment or award based on a determination of liability for bodily injury or
property damage to third parties caused by
[Insert “accidental discharges” or “sudden accidental discharges” or “nonsudden accidental
discharges” or leave blank if only corrective action is covered and this paragraph is not applicable]
arising from the operation of the above identified tank(s), or fails to pay an amount agreed to in settlement of a claim
arising from or alleged to arise from such injury or damage, the guarantor, upon written instructions from the FDEP
Secretary or designee, shall fund a standby trust in accordance with the provisions of 40 CFR 280.112 to satisfy such
judgment(s), award(s), or settlement agreement(s) up to the limits of coverage specified above.
(4) Guarantor agrees that if, at the end of any fiscal year before cancellation of this guarantee, the guarantor fails to
meet the financial test criteria of 40 CFR 280.95 (b) or (c) and (d), guarantor shall send within 120 days of such failure, by
certified mail, notice to the owner or operator. The guarantee will terminate 120 days from the date of receipt of the notice
by the owner or operator as evidenced by the return receipt.
(5) Guarantor agrees to notify the owner or operator by certified mail of a voluntary or involuntary proceeding under Title
11 (Bankruptcy), U.S. Code naming guarantor as debtor, within 10 days after commencement of the proceeding.
(6) Guarantor agrees to remain bound under this guarantee notwithstanding any modification or alteration of any
obligation of the owner or operator pursuant to 40 CFR Part 280.
(7) Guarantor agrees to remain bound under this guarantee for so long as the owner or operator must comply with the
applicable financial responsibility requirements of 40 CFR Part 280, Subpart H for the above identified tank(s), except that
guarantor may cancel this guarantee by sending notice by certified mail to the owner or operator, such cancellation to
become effective no earlier than 120 days after receipt of such notice by the owner or operator as evidenced by the return
receipt.
Part B page 2 of 3
DEP Form 62-761.900(3)
Entire form page 6 of 42
(8) The guarantor's obligation does not apply to any of the following:
(a) Any obligation of the owner or operator under a workers' compensation, disability benefits, or unemployment
compensation law or other similar law;
(b) Bodily injury to an employee of the owner or operator arising from, and in the course of, employment by the
owner or operator;
(c) Bodily injury or property damage arising from the ownership, maintenance, use, or entrustment to others of
any aircraft, motor vehicle, or watercraft;
(d) Property damage to any property owned, rented, loaned to, in the care, custody, or control of, or occupied by
the owner or operator that is not the direct result of a discharge from a storage tank;
(e) Bodily damage or property damage for the owner or operator is obligated to pay damages by reason of the
assumption of liability in a contract or agreement other than a contract or agreement entered into to meet the
requirements of 40 CFR 280.93 and/or paragraph 62-762.421(3)(c), F.A.C.
(9) Guarantor expressly waives notice of acceptance of this guarantee by the FDEP, by any or all third parties, or by the
owner or operator.
The person whose signature appears below hereby certifies that the wording of this instrument is identical to the wording
as adopted and incorporated by reference in Rule(s) 62-761.420 and/or 62-762.421, F.A.C.
[Name of Guarantor]
[Authorized Signature for Guarantor]
[Name and Title]
[Phone Number]
[Email Address]
[Signature of Witness or Notary]
[Printed Name of Witness or include Notary Seal]
[Date of Witness or Notary]
Part B page 3 of 3
DEP Form 62-761.900(3)
Entire form page 7 of 42
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