Figure: 30 TAC §37.631

CERTIFICATE OF INSURANCE FOR LIABILITY

1. (Name of Insurer), the "Insurer", of (address of Insurer) hereby certifies that the Insurer has issued liability insurance covering bodily injury and property damage to (name of Insured), the "Insured," of (address of Insured) in connection with the Insured’s obligation to demonstrate financial responsibility under 30 TAC §37.404 (relating to Liability Requirements for Sudden and Nonsudden Accidental Occurrences). The coverage applies at (list permit number, name, and physical and mailing addresses for each facility) for ("sudden accidental occurrences," "nonsudden accidental occurrences," or "sudden and nonsudden accidental occurrences;" if coverage is for multiple facilities and the coverage is different for different facilities, 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 (the dollar amount of the "each occurrence" and "annual aggregate" limits of the Insurer’s liability), exclusive of legal defense costs. The coverage is provided under policy number ___________, issued on (date). The effective date of said policy is (date).

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. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated as specified in 30 TAC §37.541 (relating to Financial Test for Liability).

          (c) Whenever required by the TCEQ executive director, the Insurer agrees to furnish to the executive director a signed duplicate original of the policy and all endorsements.

          (d) Cancellation of the insurance, whether by the Insurer, the Insured, or a parent corporation providing insurance coverage for its subsidiary or by a firm having an insurable interest in and obtaining liability insurance on behalf of the owner or operator of the facility, 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 TCEQ executive director.

          (e) Any other termination of the insurance will be effective only upon written notice and only after the expiration of 30 days after a copy of such written notice is received by the TCEQ executive director.

          I hereby certify that the wording of this instrument is identical to the wording specified in 30 TAC §37.631 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 Texas or in one or more States).

(Signature of authorized representative of Insurer) ____________________________________

(Date) ________________

(Type name) ___________________________________

(Title)___________________, Authorized Representative of (Name of Insurer)______________

(Address of Representative) _____________________________________________________