Virginia Administrative Code
Title 9 - ENVIRONMENT
Agency 20 - VIRGINIA WASTE MANAGEMENT BOARD
Chapter 170 - TRANSPORTATION OF SOLID AND MEDICAL WASTES ON STATE WATERS
Part VI - Financial Responsibility Requirements for Vessels Transporting Solid Wastes or Regulated Medical Wastes
Section 9VAC20-170-400:9 - APPENDIX IX
(NOTE: Instructions in brackets are to be replaced with the relevant information and the brackets deleted.)
CERTIFICATION OF VALID CLAIM
The undersigned, as principals and as legal representatives of [insert vessel owner or operator] and [insert name and address of third party claimant] hereby certify that the claim of bodily injury [and/or] property damage caused by a sudden and/or nonsudden accidental occurrence arising from a waste deposit from [owner or operator] vessel into state waters should be paid in the amount of $[ ].
[Signatures]
Vessel Owner or Operator
Attorney for Owner or Operator
[Notary] [Date]
[Signature(s)]
Claimant(s)
Attorney(s) for Claimant(s)
[Notary] [Date]
Statutory Authority
§§ 10.1-1402 and 10.1-1454.1 of the Code of Virginia.
