Fill and Sign the Declaratory Form

IN THE CIRCUIT COURT OF _____________ COUNTY, ____________ NAME OF PLAINTIFF ) ) ) V. ) NO. ) ) NAME OF DEFENDANT ) ) ) JURY TRIAL IS DEMANDED COMES NOW __________ (hereinafter "__________"), by and through its attorneys, and files this its Complaint against the __________, and in support thereof would show unto the Court the following: PARTIES 1. Plaintiff, __________, is a __________ corporation with its principal place of business in the State of __________, and either directly or through its predecessor in interest , at all relevant tines, was or is authorized to do business in the State of __________. 2. Defendant, __________, (formerly known as __________) is a nonprofit unincorporated legal entity created by virtue of the laws of the State of __________. The Defendant may be served with process by service upon__________, __________, pursuant to Section __________ and/or Section _________ and/or Section ________, et seq. of the __________ Code of ________, as amended. The mailing address of the Defendant's principal place of business is: __________. VENUE 3. The loss for which the Plaintiff seeks insurance coverage has occurred in __________ County, __________. ___________ Section __________ provides that actions against insurance companies may be brought in any county in which the loss occurred. Venue, therefore, is proper in the Circuit Court of __________ County. NATURE OF THE ACTION 4. Effective __________ __, ____, __________ issued to __________, a __________ corporation, its comprehensive general liability insurance policy No. __________, a complete copy of which is attached hereto as Exhibit “A”, and the provisions thereof are incorporated herein by reference, as though it were set forth in full (the “__________ policy”).5. Effective __________ __, ____, __________ Insurance Company issued to __________, a __________ corporation, its Commercial Catastrophe Liability Policy No. __________, a complete copy of which is attached hereto as Exhibit "B", and the provisions thereof are incorporated herein by reference, as though it were set forth in full (the __________ policy). 6. On or about __________ __, ____, __________, the __________corporation, was merged with and into __________, a __________ corporation, and the assets of the ___________ corporation were transferred to the __________ corporation. __________, the __________ corporation, subsequently changed its name by charter amendment to __________. 7. On or about __________ _____, __________ filed its Proof of Claim in the matter of the liquidation of __________ Insurance Company with the Insurance Department of the State of __________ and with the __________ Insurance Guaranty Association, a complete copy of said Proof of Claim is attached hereto as Exhibit "C", and the provisions thereof are incorporated herein by reference as though it were set forth in full. 8. On or about __________ _____, __________ filed its Proof of Claim in the matter of the liquidation of __________ Insurance Company with __________, Deputy Liquidator, and with the __________ Insurance Guaranty Association, a complete copy of said Proof of Claim is attached hereto as Exhibit "D", and the provisions thereof are incorporated herein by referenc e as though it were set forth in full. 9. Under the pertinent provisions of __________law, and subject to certain statutory limitations, the Defendant is deemed the insurer to the extent of its obligati ons on the covered claims and to such extent shall have all rights, duties, and obligations of the insolve nt insurer as if the insurer had not become insolvent. 10. Both __________ Insurance Company and __________ Insurance Company were amenable to the process and jurisdiction of this court and thus the Defendant is likewise amenable to such process and jurisdiction. 11. In this action, __________ seeks declaratory relief pursuant to Rule 57 of the __________ Rules of Civil Procedure adjudicating the rights and obligations of the parties under the __________ and __________ policies, and under the pertinent provisions of __________law. UNDERLYING ACTION 12. From __________ ________ to present, __________, either directly or through its predecessor in interest, has owned and operated a stoneware cooking pot manufacturing plant located in __________, __________, County, __________ ("the __________ facility"). 13. The United States Environmental Protection Agency (hereinafter referred to as "EPA") has notified ______ that ______ is a potentially responsible party for contamination at a site designated "the ________ Site" under the Comprehensive Environmental Response, Compensation, and Liability Act (hereinafter referred to as "CERCLA"), 42 U.S.C. Section 9601, et seq. The _________ Site includes the _______ facility and property adjacent to and in the vicinity thereof. 14. Investigations of the environmental conditions at the __________ Site have evidenced the existence of contamination. 15. As a result of the contamination, __________ has become liable pursuant to CERCLA to conduct investigations and remediation of certain environmental conditions. 16. At the direction of EPA, __________ is carrying out remedial activities with respect to contamination detected at and emanating from the __________ Site. BACKGROUND OF CLAIMS 17. The __________ policy provides that __________ is obligated to defend and indemnify the insured, subject to a $00.00 self-insured retention, for all property damage caused by an "occurrence" in the amount of $00.00. 18. The __________ policy provides that __________ is obligated to defend and indemnify the insured for all property damage caused by an "occurrence" to the extent not covered by an underlying comprehensive general liability policy in the amount of $00.00 ea ch occurrence, $00.00 aggregate. The limits of liability under the Integrity policy are $00.00 e ach occurrence, $00.00 annual aggregate. 19. The contamination at and emanating from the __________ Site was neither expected nor intended from the stand-point of __________ and occurred in part during the periods of the __________ and __________ policies. 20. The contamination at and emanating from the __________ Site constitutes property damage as defined by the __________ and __________ policies. 21. __________ expended substantial premiums to purchase the __________ and __________ policies. 22. __________ has expended, and continues to expend, substantial expenses relating to property damage to the __________ site. 23. The damages claimed by the United States and all sums expended to date in connection with such damage are within the coverage of the __________ policy, and within the coverage of the __________ policy, to the extent not covered by the underlying coverage. 24. To the extent provided by pertinent __________ law, the Defendant is obligated to pay in full the costs and expenses of __________ in defense of the underlying action, and is obligated to indemnify __________ in full for such liability arising from the underlying action by way of settlement, compromise, or adjudication. DECLARATORY JUDGMENT 25. Plaintiff repeats and realleges each and every allegation contained in Pa ragraphs 1 through 24 as if fully set forth herein. 26. An actual controversy exists between Plaintiff and the Defendant as to whether Plaintiff is entitled to the costs of its defense, including, but not limited t o, all amounts expended in defense costs to date, and between Plaintiff and Defendant as to whether Plainti ff is entitled to indemnification for all losses incurred in connection with proceedings commenced and cla ims made by the United States with respect to property damage at and emanating from t he __________ Site, to the extent covered by the __________ and __________ policies. 27. To protect its rights and interests, Plaintiff requires a declaration that the Defe ndant, subject to statutory limitations of pertinent __________law, is obligated to pay on behal f of __________ all sums which __________ shall be obligated to pay because of the property damage resulting from an "occurrence" which was unintended and unexpected by __________ during the policy periods covered by the __________ and __________ policies. WHEREFORE, Plaintiff requests judgment as follows: 1. That this Court determine and declare that the Defendant is liable to pay and indemnify Plaintiff for all damages, costs and payments incurred or to be incurred by Plaintiff with respect to any and all claims related to contamination of t he __________ Site or for which it is otherwise liable with respect to contamination at the __________ Site, subject to the coverage limits of the __________ and __________ policies and the pertinent provisions of __________ law; and 2. Grant to __________ its costs and attorney's fees incurred herein; and 3. Grant such other and further relief as may be just and proper; and 4. Plaintiff demands a jury trial on all issues. Respectfully submitted, ________________________ BY: ATTORNEYS FOR THE PLAINTIFF