9VAC25-590-260:10. APPENDIX X. CERTIFICATION OF VALID CLAIM

APPENDIX X. CERTIFICATION OF VALID CLAIM. [Note: The instructions in brackets are to be replaced by the relevant information and the brackets deleted.] The undersigned, as principals and as legal representatives of [insert 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 an accidental release arising from operating [owner's or operator's] underground storage tank should be paid in the amount of $[.....] [Signatures] [Signature(s)] Owner or Operator Claimant(s) Attorney for Attorney(s) for Owner or Operator Claimant(s) (Notary) Date (Notary) Date