7 Del. Admin. Code § 1352-D-24.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 1352-D-24.0 - Form D - AST Certificate of Insurance

Name: __________________________________________[name of each covered location]

Address: ____________________________________[address of each covered location]

__________________________________________________________________________

__________________________________________________________________________

Policy Number: ____________________________________________________________

Endorsement (if applicable): __________________________________________________

Period of Coverage: _______________________________________ [current policy period]

Name of [Insurer or Risk Retention Group]: ______________________________________

Address of [Insurer or Risk Retention Group]:

______________________________________________________________________________

______________________________________________________________________________

Name of [Insured]: _____________________________________________________________

Address of [Insured]: ___________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Certification:

1. [Name of the Insurer or Risk Retention Group], the "Insurer" or "Group," as identified above, hereby certifies that it has issued liability insurance covering the following aboveground storage tanks (ASTs):

List for each Facility: the name and address of the Facility where ASTs assured by this Policy are located, and indicate which ASTs are assured by this Policy. List each AST by the AST identification number provided in the registration form submitted pursuant to PART A of this regulation.

AST Facility I.D. Number: ____________________ (as listed on DNREC registration certificate)

Facility Name: ______________________________________________________________

Facility Street: ______________________________________________________________

Facility City: _____________________________________ Facility Zip Code: ____________

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For [insert: "taking Corrective Action" and/or "compensating third parties for Bodily Injury and Property Damage" caused by Accidental Releases] 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 AST(s) identified above).

The limits of liability are [insert the dollar amount of the "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 ASTs or locations, indicate the amount of coverage for each type of coverage and/or for each AST or location)], exclusive of Legal Defense Costs which are subject to separate limits under the policy. This coverage is provided under [policy number]. The Effective Date of said policy is [date].

2. The "Insurer" or "Group" 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" or "Group" of its obligations under the policy to which this certificate applies.

b. The "Insurer" or "Group" is liable for the payment of amounts within any deductible applicable to the policy to the provider of Corrective Action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by the "Insurer" or "Group." 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 Sections 5.0 through 15.0 of this Part.

c. Whenever requested by the Department, the ["Insurer" or "Group"] agrees to furnish to the Department a signed duplicate original of the policy and all endorsements.

d. Cancellation or any other Termination of the insurance by the ["Insurer" or "Group"], except for non-payment of premium or misrepresentation by the insured, shall 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.

e. Cancellation for non-payment of premium or misrepresentation by the insured shall be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured.

f. Insert for claims-made policies:

The insurance covers claims otherwise covered by the policy that are reported to the ["Insurer" or "Group"] within six months of the Effective Date of the cancellation or non-renewal 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.

g. In the event of termination or nonrenewal of the insurance by the ["Insurer" or "Group"], the insurer shall notify the Department by Verifiable Service, of termination or nonrenewal not more than 30 Days after the termination or nonrenewal. The notice shall state the name and address of the insured, the date of termination or nonrenewal, and the address of the ASTs previously insured.

I hereby certify that the wording of this instrument is identical to the wording in PART D, Section 23.0, Form D of the Delaware Regulations Governing Aboveground Storage Tanks as constituted on the date shown immediately below and that the ["Insurer" or "Group"] 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."

Signature of authorized representative of [Insurer or Risk Retention Group]:

_____________________________________________________________________________

Name of Person signing: ______________________________________________________

Print legibly or type

Title of Person signing: ______________________________________________________

Print legibly or type

Authorized Representative of [Insurer or Risk Retention Group]

Address of Representative: ______________________________________________________

Print legibly or type

_____________________________________________________________________________

7 Del. Admin. Code § 1352-D-24.0

20 DE Reg. 815 (4/1/2017)
27 DE Reg. 536 (1/1/2024) (Final)