Certification of Financial Responsibility
["Owner" or "Operator"] hereby certifies that it is in compliance with the requirements 310 CMR 80.51 through 80.63.
The financial assurance mechanism(s) used to demonstrate financial responsibility under 310 CMR 80.51 through 80.63 is (are) as follows:
[For each mechanism, list the type of mechanism, name of issuer, mechanism number (if applicable), amount of coverage, effective period of coverage and whether the mechanism covers "taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases".]
[Signature of Owner or Operator]
[Name of Owner or Operator]
[Title]
[Date]
[Signature of witness or notary]
[Name of witness or notary]
[Date]
310 CMR, § 80.59