Virginia Administrative Code › Title 9 - ENVIRONMENT › Agency 25 - STATE WATER CONTROL BOARD › Chapter 640 - ABOVEGROUND STORAGE TANK AND PIPELINE FACILITY FINANCIAL RESPONSIBILITY REQUIREMENTS › Section 9VAC25-640-250:3 - APPENDIX III. ENDORSEMENT

Current through Register Vol. 40, No. 24, July 15, 2024
(Note: The instructions in brackets are to be replaced by the
				  relevant information and the brackets deleted.)
Name: ________ [name of each covered location]
				  _____________
Address: _____ [address of each covered location]
				  _____________
Policy Number: _____________
Period of Coverage: ____ [current policy period]
				  _____________
Name of Insurer:
_____________
_____________
Address of Insurer:
_____________
_____________
Name of Insured: _____________
Address of Insured:
_____________
_____________
_____________
Endorsement:
1. This
				endorsement certifies that the policy to which the endorsement is attached
				provides liability insurance covering the following aboveground storage tanks
				and/or pipelines in connection with the insured's obligation to demonstrate
				financial responsibility under 9VAC25-640:
[List for each facility: the name and address of the facility
				  where tanks assured by this mechanism are located, either the registration
				  identification number assigned by the department or the Oil Discharge
				  Contingency Plan facility identification number, and whether tanks are assured
				  by this mechanism. If more than one instrument is used to assure different
				  tanks at any one facility, list each tank assured by this mechanism.
List for each pipeline: the home office address and the names
				  of the cities and counties in the Commonwealth where the pipeline is
				  located.]
for containment and clean up of a discharge of oil in
				  accordance with and subject to the limits of liability, exclusions, conditions,
				  and other terms of the policy; [if coverage is different for different tanks or
				  locations, indicate the type of coverage applicable to each tank or location]
				  arising from operating the aboveground storage tank(s) and/or pipelines
				  identified above.
The limits of liability are [insert the dollar amount of the
				  containment and clean up "each occurrence" and "annual aggregate" limits of the
				  Insurer's or Group's liability; if the amount of coverage is different for
				  different types of coverage or for different aboveground storage tanks,
				  pipelines or locations, indicate the amount of coverage for each type of
				  coverage and/or for each aboveground storage tank, pipeline or location],
				  exclusive of legal defense costs, which are subject to a separate limit under
				  the policy. This coverage is provided under [policy number]. The effective date
				  of said policy is [date].
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
				inconsistent with subsections (a) through (d) for occurrence policies and (a)
				through (e) for claims-made policies 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 to the provider of
				containment and clean up, 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 under another mechanism or
				  combination of mechanisms as specified in
				  9VAC25-640-70
				  through
				  9VAC25-640-120.
c. Whenever requested by the
				Department of Environmental Quality, the Insurer agrees to furnish to the
				Department of Environmental Quality a signed duplicate original of the policy
				and all endorsements.
d.
				Cancellation or any other termination of the insurance by the Insurer, except
				for on-payment of premium or misrepresentation by the insured, will be
				effective only upon written notice and only after the expiration of 60 days
				after a copy of such written notice is received by the insured and the
				Department of Environmental Quality. Cancellation for non-payment of premium or
				misrepresentation by the insured will be effective only upon written notice and
				only after expiration of a minimum of 15 days after a copy of such written
				notice is received by the insured and the Department of Environmental Quality.
[Insert for claims-made policies:
e. The insurance covers claims otherwise
				covered by the policy that are reported to the Insurer within six months of the
				effective date of cancellation or nonrenewal of the policy except where the new
				or renewed policy has the same retroactive date or a retroactive date earlier
				than that of the prior policy, and which arise out of any covered occurrence
				that commenced after the policy retroactive date, if applicable, and prior to
				such policy renewal or termination date. Claims reported during such extended
				reporting period are subject to the terms, conditions, limits, including limits
				of liability, and exclusions of the policy.]
I hereby certify that the wording of this endorsement is in
				  no respect less favorable than the coverage specified in Appendix III of
				  9VAC25-640 and has been so certified by the State Corporation Commission of the
				  Commonwealth of Virginia. I further 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 the Commonwealth of Virginia.
[Signature of authorized representative of Insurer]
[Name of person signing]
[Title of person signing], Authorized Representative of [name
				  of Insurer]
[Address of Representative]