Certification of Valid Claim The undersigned, as parties Principal and name and address of third-party claimant(s), hereby certify that the claim of bodily injury and/or property damage caused by a accidental occurrence arising from operating Principal's hazardous waste treatment, storage, or disposal facility should be paid in the amount of $ [Signatures]_____________________ Principal _______________________ (Notary) Date ___________________ [Signatures}_______________________ Claimant(s) ________________________ (Notary)Date_______________________ A valid final court order establishing a judgment against the Principal for bodily injury or property damage caused by sudden or nonsudden accidental occurrences arising from the operation of the facility or group of facilities. Principal’s In the event of combination of this guarantee with another mechanism to meet liability requirements, this guarantee will be considered coverage. I hereby certify that the wording of this guarantee is identical to the wording specified in APC&EC Regulation No. 23 § 264.151(h)(2) as such regulations were constituted on the date shown immediately below. Effective Date: ____________________________ (Guarantor)
Certification of Valid Claim The undersigned, as parties Principal and name and address of third-party claimant(s), hereby certify that the claim of bodily injury and/or property damage caused by a accidental occurrence arising from operating Principal's hazardous waste treatment, storage, or disposal facility should be paid in the amount of $ [Signatures]_____________________ Principal _______________________ (Notary) Date ___________________ [Signatures}_______________________ Claimant(s) ________________________ (Notary)Date_______________________ A valid final court order establishing a judgment against the Principal for bodily injury or property damage caused by sudden or nonsudden accidental occurrences arising from the operation of the Principal’s facility or group of facilities. In the event of combination of this guarantee with another mechanism to meet liability requirements, this guarantee will be considered coverage. I hereby certify that the wording of this guarantee is identical to the wording specified in APC&EC Regulation No. 23 § 264.151(h)(2) as such regulations were constituted on the date shown immediately below. Effective Date: ____________________________ (Guarantor)