9 Va. Admin. Code § 25-640-250:10
(Note: The instructions in brackets are to be replaced by the relevant information and the brackets deleted.)
[Name and Address of Bank]
City _______________________ ____________, 20__
___ FOR VALUE RECEIVED, the undersigned assigns all right, title, and interest to the Department of Environmental Quality, Commonwealth of Virginia, and its successors and assigns the Department of Environmental Quality the principal amount of the instrument, including all moneys deposited now or in the future to that instrument, indicated below:
__If checked here, this assignment includes all interest now and hereafter accrued.
Certificate of Deposit Account No. _____________________
This assignment is given as security to the Department of Environmental Quality in the amount of _______________________ Dollars ($_____________).
Continuing Assignment. This assignment shall continue to remain in effect for all subsequent terms of the automatically renewable certificate of deposit.
Assignment of Document. The undersigned also assigns any certificate or other document evidencing ownership to the Department of Environmental Quality.
Additional Security. This assignment shall secure the payment of any financial obligation of [name of operator] to the Department of Environmental Quality to cover containment and clean up necessitated by discharges of oil arising from operating the aboveground storage tank(s) and pipelines identified below in the amount of [in words] $ [insert dollar amount] per occurrence and [in words] $ [insert dollar amount] annual aggregate:
[List for each facility: the name and address of the facility where tanks assured by this mechanism are located, either the registration identification number assigned by the Department or the Oil Discharge Contingency Plan facility identification number, and whether tanks are assured by this mechanism. If more than one instrument is used to assure different tanks at any one facility, list each tank covered by this instrument.
For pipelines, list: the home office address and the names of the cities and counties in the Commonwealth where the pipeline is located.]
The certificate of deposit may not be drawn on to cover any of the following:
Application of Funds. The undersigned agrees that all or any part of the funds of the indicated account or instrument may be applied to the payment of any and all financial responsibility obligations of [name of operator] to the Department of Environmental Quality to cover containment and clean up necessitated by discharges of oil arising from operating the aboveground storage tank(s) and pipelines at the [facility name and address]. The undersigned authorizes the Department of Environmental Quality to withdraw any principal amount on deposit in the indicated account or instrument including any interest, if indicated, and to apply it in the Department of Environmental Quality's discretion to fund containment and clean up necessitated by discharges of oil arising from operating the aboveground storage tank(s) and pipelines at the [facility name] or in the event of [operator's] failure to comply with the Aboveground Storage Tank and Pipeline Facility Financial Responsibility Requirements, 9VAC25-640. The undersigned agrees that the Department of Environmental Quality may withdraw any principal and/or interest from the indicated account or instrument without demand or notice. [The undersigned] agrees to assume any and all loss of penalty due to federal regulations concerning the early withdrawal of funds. Any partial withdrawal of principal or interest shall not release this assignment.
The party or parties to this Assignment set their hand or seals, or if corporate, has caused this assignment to be signed in its corporate name by its duly authorized officers and its seal to be affixed by authority of its Board of Directors the day and year above written.
The party or parties to this Assignment also certify that the wording of this Assignment is identical to the wording specified in Appendix X of 9VAC25-640 as such regulations were constituted on the date this Assignment was executed.
SEAL | ||
[Operator] | ||
[print Operator's name] | [Date] | |
SEAL | ||
[Operator] | ||
[print Operator's name] | [Date] |
THE FOLLOWING SECTION IS TO BE COMPLETED BY THE BRANCH OR LENDING OFFICE:
The signature(s) as shown above compare correctly with the name(s) as shown on record as owner(s) of the Certificate of Deposit indicated above. The above assignment has been properly recorded by placing a hold in the amount of $ _______________________ for the benefit of the Department of Environmental Quality, Commonwealth of Virginia.
___ If checked here, the accrued interest on the Certificate of Deposit indicated above has been maintained to capitalize versus being mailed by check or transferred to a deposit account.
[Signature] | [Date] | |
[print name] | ||
[Title] | ||
Mailing address of branch or lending office | ||
Area code and telephone number of branch or lending office |
9 Va. Admin. Code § 25-640-250:10
Statutory Authority: §§ 62.1-44.15 and 62.1-44.34:16 of the Code of Virginia.