Section 329IAC3.1-14-30. Wording of instrument; certificate of insurance

   A certificate of insurance, as specified in section 8 or 18 of this rule, 329 IAC 3.1-15-4(f), or 329 IAC 3.1-15-6(f) (see 329 IAC 3.1-15-10(e)), must be worded as follows except that instructions in brackets are to be replaced with the relevant information and the brackets deleted:

Certificate of Insurance for Closure or Post-Closure Care

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

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

  Facilities Covered: [List for each facility: the EPA identification number, name, address, and the amount of insurance for closure and/or the amount for post-closure. (These amounts for all facilities covered must total the face amount shown below.)]

  Face Amount:  

  Policy Number:  

  Effective Date:  

  The Insurer hereby certifies that it has issued to the Insured the policy of insurance identified above to provide financial assurance for [insert "closure" or "closure and post-closure care" or "post-closure care"] for the facilities identified above. The Insurer further warrants that such policy conforms in all respects with the requirements of 329 IAC 3.1-14-8, 329 IAC 3.1-14-18, 329 IAC 3.1-15-4(f), or 329 IAC 3.1-15-6(f) (see 329 IAC 3.1-15-10(e)) 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 Indiana Department of Environmental Management (IDEM) commissioner, the Insurer agrees to furnish to the IDEM commissioner 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 329 IAC 3.1-14-30 as such rule was constituted on the date shown immediately below.

  [Authorized signature for Insurer]

  [Name of person signing]

  [Title of person signing]

Signature of witness or notary:

  [Date]

(Solid Waste Management Division; 329 IAC 3.1-14-30; filed Jan 24, 1992, 2:00 p.m.: 15 IR 973; filed Apr 1, 1996, 11:00 a.m.: 19 IR 1998; readopted filed Jan 10, 2001, 3:25 p.m.: 24 IR 1535)