DEP Form 62-730.900(5)(a) "Certificate of Liability Insurance - Hazardous Waste Transporter and Used Oil Handler" - Florida

What Is DEP Form 62-730.900(5)(a)?

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 February 4, 2013;
  • 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(5)(a) 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(5)(a) "Certificate of Liability Insurance - Hazardous Waste Transporter and Used Oil Handler" - Florida

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Mail original completed form to:
Department of Environmental Protection
For assistance call: 850-245-8707
2600 Blair Stone Road, Mail Station 4560
Tallahassee, Florida 32399-2400
STATE OF FLORIDA
CERTIFICATE OF LIABILITY INSURANCE
HAZARDOUS WASTE TRANSPORTER AND USED OIL HANDLER
1.
_____________________________________________________________________________________
(Name of Insurer)
(the "Insurer"), of_________________________________________________________ ______________
(Address of Insurer)
hereby certifies that it has issued liability insurance covering bodily injury and property damage including
environmental restoration for sudden accidental occurrences to
_____________________________________________________________________________________
(Name of Insured)
(the "Insured"), of ______________________________________________________________________
(Physical Address of Insured)
in connection with the insured's obligation to demonstrate financial responsibility under Florida
Administrative Code Rule 62-710.600(2) and 62-730.170. The coverage applies at:
EPA/DEP I.D. No.
Name
Physical Address
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(If coverage is for multiple facilities, identify each facility insured.)
This insurance is primary and the company shall not be liable for amounts in excess of
$___________________for each accident, exclusive of legal defense costs. The coverage is provided
under policy number ________________, issued on ___________________.
(date)
The effective date of said policy is_____________________ and the expiration date of said policy
(date)
is____________________________.
(date)
This insurance is excess and the company shall not be liable for amounts in excess of
$_____________________for each accident in excess of the underlying limit of
$_____________________for each accident, exclusive of legal defense costs. The coverage is provided
under policy number____________________, issued on____________________. The effective date of
(date)
said policy is ___________________and the expiration date of said policy is ______________________.
(date)
(date)
Page 1 of 2
DEP FORM 62-730.900(5)(a), incorporated in Rule 62-730.170(2)(b), and 62-710.600(2)(e), F.A.C., Effective Date 4-23-13
Mail original completed form to:
Department of Environmental Protection
For assistance call: 850-245-8707
2600 Blair Stone Road, Mail Station 4560
Tallahassee, Florida 32399-2400
STATE OF FLORIDA
CERTIFICATE OF LIABILITY INSURANCE
HAZARDOUS WASTE TRANSPORTER AND USED OIL HANDLER
1.
_____________________________________________________________________________________
(Name of Insurer)
(the "Insurer"), of_________________________________________________________ ______________
(Address of Insurer)
hereby certifies that it has issued liability insurance covering bodily injury and property damage including
environmental restoration for sudden accidental occurrences to
_____________________________________________________________________________________
(Name of Insured)
(the "Insured"), of ______________________________________________________________________
(Physical Address of Insured)
in connection with the insured's obligation to demonstrate financial responsibility under Florida
Administrative Code Rule 62-710.600(2) and 62-730.170. The coverage applies at:
EPA/DEP I.D. No.
Name
Physical Address
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
(If coverage is for multiple facilities, identify each facility insured.)
This insurance is primary and the company shall not be liable for amounts in excess of
$___________________for each accident, exclusive of legal defense costs. The coverage is provided
under policy number ________________, issued on ___________________.
(date)
The effective date of said policy is_____________________ and the expiration date of said policy
(date)
is____________________________.
(date)
This insurance is excess and the company shall not be liable for amounts in excess of
$_____________________for each accident in excess of the underlying limit of
$_____________________for each accident, exclusive of legal defense costs. The coverage is provided
under policy number____________________, issued on____________________. The effective date of
(date)
said policy is ___________________and the expiration date of said policy is ______________________.
(date)
(date)
Page 1 of 2
DEP FORM 62-730.900(5)(a), incorporated in Rule 62-730.170(2)(b), and 62-710.600(2)(e), F.A.C., Effective Date 4-23-13
Mail original completed form to:
Department of Environmental Protection
For assistance call: 850-245-8707
2600 Blair Stone Road, Mail Station 4560
Tallahassee, Florida 32399-2400
2.
The Insurer further certifies the following with respect to the insurance described in Paragraph 1:
(a)
Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the
policy.
(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.
(c)
Whenever requested by the Secretary (or designee) of the Florida Department of Environmental
Protection (FDEP), the Insurer agrees to furnish to the Department a signed duplicate original of
the policy and all endorsements.
(d)
Cancellation of the insurance, whether by the Insurer or the Insured and any other termination of
the insurance (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 as evidenced by certified mail return receipt.
(e)
The Insurer shall not be liable for the payment of any judgment or judgments against the Insured
for claims resulting from accidents which occur after the termination of the insurance described
herein, but such termination shall not affect the liability of the Insurer for the payment of any
such judgment or judgments resulting from accidents which occur during the time the policy is
in effect.
I hereby certify 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 of more States including Florida.
____________________________________________________________
(Signature of Authorized Representative of Insurer)
____________________________________________________________
(Typed name)
____________________________________________________________
(Title)
Authorized Representative of
_____________________________________________________________
(Name of Insurer)
_____________________________________________________________
(Address of Representative)
Page 2 of 2
DEP FORM 62-730.900(5)(a), incorporated in Rule 62-730.170(2)(b), and 62-710.600(2)(e), F.A.C., Effective Date 4-23-13
Page of 2