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II.Non-Recovery From Other Sources Disclosure Certification <br /> 1. Insurance <br /> Is there an insurance policy covering spills,overfills or releases from the UST(s)? No <br /> If you answered"yes,"attach a copy of the policy and provide the following data;if you answered"no,"please skip to question 2. <br /> a. Have you already or do you intend to file a claim with the insurance company? <br /> If you answered"yes,"attach a copy of the claim and itemized settlement or provide the status of the claim if not settled. <br /> b.If you answered"no,"provide your reason in the space below. <br /> 2. Litigation <br /> Do you contend that any other person is liable or otherwise responsible for the release? No <br /> If you answered"yes,"provide the following data;if you answered"no,"please skip to question 3. <br /> a. Have you sought,or do you intend to seek money from any other party potentially responsible for the release? <br /> If you answered "yes,"attach an explanation of the potentially responsible party and the status of the litigation. If legal action has <br /> commenced, provide the case number and the county in which the action has been filed. Attach a copy of the complaint and any <br /> complaint amendments. <br /> b.If you answered"no,"provide your reasons in the space below. <br /> 3. Other Source Funds <br /> Have you,or anyone acting on your behalf,received funds from any other source not described above(including,but not limited to, <br /> contributions from other potentially responsible parties, lending institutions or any other source regardless of how the funds were <br /> characterized) related in any way to the release for which you request reimbursement from the Leaking Petroleum Underground <br /> Storage Tank Cleanup Fund? No <br /> If you answered"yes,"provide the following data;if you answered"no,"please skip to Section III. <br /> a.Attach an explanation of the date funds received, source of funds, what the funds paid for and the amount. If any of the money <br /> received was for purposes other than contamination cleanup costs,attach documentation(settlement agreement,pleading,judgements, <br /> or any other document that identifies the purpose(s)for which the money was received)to support that fact. <br /> b.Are you obligated to repay any part of the funds received? <br /> If you answered"yes,"attach documentation indicating amount to be repaid. <br /> 3 DWM/UST V.8/1/19 <br />