CERTIFICATE OF INSURANCE FOR COMMERCIAL LIABILITY
Name and Address of Insurer (herein called the "Insurer"):
___________________________________________________________________________________
___________________________________________________________________________________
Name and Physical and Mailing Addresses of Insured (herein called the "Insured"):
___________________________________________________________________________________
___________________________________________________________________________________
Additional Insured: Texas Commission on Environmental Quality
Physical Address: 12100 Park 35 Circle, MC 184, Austin, TX 78753
Mailing Address: MC 184, P. O. Box 13087, Austin, TX 78711-3087
Facilities covered: (list for each facility: permit number, name, and physical and mailing addresses)
Per Occurrence Limit: ______________________________________________
Annual Aggregate Limit: _____________________________________________
Policy Number: ___________________________________________________
Effective Date: ____________________________________________________
The Insurer hereby certifies that it has issued to the Insured a commercial liability policy of insurance identified above to provide coverage for bodily injury and property damage to compensate persons injured or property damaged as a result of Class B sewage sludge land application at the facilities identified above.
The Insurer further warrants that such policy conforms in all respects with the requirements of 30 Texas Administrative Code (TAC) §37.9100 (relating to Commercial Liability Insurance), as applicable and as such regulations were constituted on the date shown immediately below. It is agreed that any provision of the policy inconsistent with such regulations is hereby amended to eliminate such inconsistency.
Whenever requested by the executive director of the Texas Commission on Environmental Quality, the Insurer agrees to furnish to the executive director a duplicate original of the policy listed above, including all endorsements thereon.
I hereby certify that the wording of this certificate is identical to the wording specified in 30 TAC §37.9145 (relating to Certificate of Insurance for Commercial Liability) as such regulations were constituted on the date shown immediately below. The undersigned Insurer certifies that it is authorized to transact or be a surplus lines insurer eligible to engage in the business of insurance in Texas and it has a minimum financial strength rating of A- as assigned by the A.M. Best Company.
Authorized signature of Insurer: _____________________________________
Name of person signing: ___________________________________________
Title of person signing: ____________________________________________
Signature of witness or notary: ______________________________________
Date: ________________