Certification of Valid Claim
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]
Owner or Operator
Attorney for Owner or Operator
[Notary]
Date
[Signature(s)]
Claimant(s)
Attorney(s) for Claimant(s)
[Notary]
Date _________ or
N.D. Admin Code 33.1-24-08-102
General Authority: NDCC 23.1-04-03, 23.1-04-06; S.L. 2017, ch. 199, § 1
Law Implemented: NDCC 23.1-04-06; S.L. 2017, ch. 199, § 19