DEP Form 62-730.900(4)(M) "Hazardous Waste Facility Endorsement (Primary Policy)" - Florida

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

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 5, 1995;
  • 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)(M) 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)(M) "Hazardous Waste Facility Endorsement (Primary Policy)" - Florida

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DEP Form # 62-730.900(4)(m)
Form Title HW Facility Endorsement (Primary Policy)
Effective Date January 5, 1995
DEP Application No.
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY ENDORSEMENT
(Primary Policy)
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 40 CFR 264.147 or 265.147 as adopted by reference in Section
62-730.180, Florida Administrative Code (F.A.C.). The coverage applies at:
EPA/DEP I.D. No.
Name
Address
for:
sudden accidental occurrences
nonsudden accidental occurrences
sudden and nonsudden accidental occurrences.
If coverage is for multiple facilities and the coverage is different for different facility(ies), indicate 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 $
each occurrence and $
annual aggregate in excess of the underlying limits of $
each occurrence and
$
annual 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 subsections (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 reimbursement 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 40 CFR 264.147(f) or 265.147(f), as adopted by reference in Section
62-730.180, F.A.C.
(c)
Whenever requested by the Secretary of the Florida Department of Environmental Protection
(FDEP), the Insurer agrees to furnish to the Secretary a signed duplicate original of the policy
and all endorsements.
(d)
Cancellation of this endorsement, whether by the Insurer or the insured, 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 Secretary of the FDEP.
(e)
Any other termination of this endorsement (e.g., expiration, non-renewal) 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 Secretary of the FDEP.
DEP FORM 62-730.900(4)(m)
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PRINT
CLEAR
DEP Form # 62-730.900(4)(m)
Form Title HW Facility Endorsement (Primary Policy)
Effective Date January 5, 1995
DEP Application No.
STATE OF FLORIDA
HAZARDOUS WASTE FACILITY ENDORSEMENT
(Primary Policy)
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 40 CFR 264.147 or 265.147 as adopted by reference in Section
62-730.180, Florida Administrative Code (F.A.C.). The coverage applies at:
EPA/DEP I.D. No.
Name
Address
for:
sudden accidental occurrences
nonsudden accidental occurrences
sudden and nonsudden accidental occurrences.
If coverage is for multiple facilities and the coverage is different for different facility(ies), indicate 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 $
each occurrence and $
annual aggregate in excess of the underlying limits of $
each occurrence and
$
annual 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 subsections (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 reimbursement 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 40 CFR 264.147(f) or 265.147(f), as adopted by reference in Section
62-730.180, F.A.C.
(c)
Whenever requested by the Secretary of the Florida Department of Environmental Protection
(FDEP), the Insurer agrees to furnish to the Secretary a signed duplicate original of the policy
and all endorsements.
(d)
Cancellation of this endorsement, whether by the Insurer or the insured, 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 Secretary of the FDEP.
(e)
Any other termination of this endorsement (e.g., expiration, non-renewal) 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 Secretary of the FDEP.
DEP FORM 62-730.900(4)(m)
Page 1 of 2
Attached to and forming part of policy No.
issued by
,
Name of Insurer
herein called the Insurer, of
to
Address of Insurer
of
Name of Insured
this
Address of Insured
day of
, 19
. The effective date of said policy is
day of
, 19
.
Day
Month
Year
Day
Month
Year
I hereby certify that the wording of this endorsement is substantially identical to the wording specified in 40
CFR 264.151(i), as adopted by reference in Section 62-730.180, F.A.C., as such regulation was constituted on the
date first above written, and that the Insurer is licensed to transact the business of insurance, or eligible to
provide insurance as an excess or surplus lines insurer, in one or more states including Florida.
Signature of Authorized Representative of Insurer, who is a Resident Agent of Florida
Type Name
Social Security Number
Title
Authorized Representative of
Name of Insurer
Address of Representative
DEP FORM 62-730.900(4)(m)
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