Figure: 30 TAC §37.9155

CERTIFICATE OF INSURANCE FOR ENVIRONMENTAL IMPAIRMENT

Name and Address of Insurer (herein called the "Insurer"):

___________________________________________________________________________________

___________________________________________________________________________________

Name and Physical and Mailing Addresses of Insured (herein called the "Insured"):

___________________________________________________________________________________

___________________________________________________________________________________

Facilities covered: (list for each facility: permit number, name, and physical and mailing addresses)

Per Occurrence Limit: ______________________________________________

Policy Limit: ______________________________________________________

Policy Number: ____________________________________________________

Effective Date: _____________________________________________________

          The Insurer hereby certifies that it has issued to the Insured an environmental impairment policy of insurance identified above to provide financial assurance for corrective action related to the facilities identified above. The Insurer further warrants that such policy conforms in all respects with the requirements of 30 Texas Administrative Code (TAC) §37.9105 (relating to Environmental Impairment 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 §37.9155 (relating to Certificate of Insurance for Environmental Impairment) 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: ________________