Appendix B to Part 515 - Ocean Transportation Intermediary (OTI) Insurance Form [Form 67]
46:9.0.1.2.10.7.1.1.9 : Appendix B
Appendix B to Part 515 - Ocean Transportation Intermediary (OTI)
Insurance Form [Form 67]
Form FMC-67 Federal Maritime
Commission Ocean Transportation Intermediary (OTI) Insurance Form
Furnished as Evidence of Financial Responsibility Under 46 U.S.C.
40901-40904
This is to certify, that the (Name of Insurance Company),
(hereinafter “Insurer”) of (Home Office Address of Company) has
issued to (OTI or Group or Association of OTIs [indicate whether
NVOCC(s) or Freight Forwarder(s)]) (hereinafter “Insured”) of
(Address of OTI or Group or Association of OTIs) a policy or
policies of insurance for purposes of complying with the provisions
of Section 19 of the Shipping Act of 1984 (46 U.S.C. 40901-40904)
and the rules and regulations, as amended, of the Federal Maritime
Commission, which provide compensation for damages, reparations or
penalties arising from the transportation-related activities of
Insured, and made pursuant to the Shipping Act of 1984 (46 U.S.C.
40101-41309) (Shipping Act).
Whereas, the Insured is or may become an OTI subject to the
Shipping Act and the rules and regulations of the Federal Maritime
Commission, or is or may become a group or association of OTIs, and
desires to establish financial responsibility in accordance with
section 19 of the Shipping Act (46 U.S.C. 40901-40904), files with
the Commission this Insurance Form as evidence of its financial
responsibility and evidence of a financial rating for the Insurer
of Class V or higher under the Financial Size Categories of A.M.
Best & Company or equivalent from an acceptable international
rating organization on such organization's letterhead or designated
form, or, in the case of insurance provided by Underwriters at
Lloyd's, documentation verifying membership in Lloyd's, or, in the
case of surplus lines insurers, documentation verifying inclusion
on a current “white list” issued by the Non-Admitted Insurers'
Information Office of the National Association of Insurance
Commissioners.
Whereas, the Insurance is written to assure compliance by the
Insured with section 19 of the Shipping Act (46 U.S.C.
40901-40904), and the rules and regulations of the Federal Maritime
Commission relating to evidence of financial responsibility for
OTIs, this Insurance shall be available to pay any judgment
obtained or any settlement made pursuant to a claim under 46 CFR
515.23 for damages against the Insured arising from the Insured's
transportation-related activities under the Shipping Act, or order
for reparations issued pursuant to section 11 of the Shipping Act
(46 U.S.C. 41301-41302, 41305-41307(a)), or any penalty assessed
against the Insured pursuant to section 13 of the Shipping Act (46
U.S.C. 41107-41109).
Whereas, the Insurer certifies that it has sufficient and
acceptable assets located in the United States to cover all
liabilities of Insured herein described, this Insurance shall inure
to the benefit of any and all persons who have a bona fide claim
against the Insured pursuant to 46 CFR 515.23 arising from its
transportation-related activities under the Shipping Act, or order
of reparation issued pursuant to section 11 of the Shipping Act (46
U.S.C. 41301-41302, 41305-41307(a)), and to the benefit of the
Federal Maritime Commission for any penalty assessed against the
Insured pursuant to section 13 of the Shipping Act (46 U.S.C.
41107-41109).
The Insurer consents to be sued directly in respect of any bona
fide claim owed by Insured for damages, reparations or penalties
arising from the transportation-related activities under the
Shipping Act, of Insured in the event that such legal liability has
not been discharged by the Insured or Insurer after a claimant has
obtained a final judgment (after appeal, if any) against the
Insured from a United States Federal or State Court of competent
jurisdiction and has complied with the procedures for collecting on
such a judgment pursuant to 46 CFR 515.23, the Federal Maritime
Commission, or where all parties and claimants otherwise mutually
consent, from a foreign court, or where such claimant has become
entitled to payment of a specified sum by virtue of a compromise
settlement agreement made with the Insured and/or Insurer pursuant
to 46 CFR 515.23, whereby, upon payment of the agreed sum, the
Insurer is to be fully, irrevocably and unconditionally discharged
from all further liability to such claimant; provided, however,
that Insurer's total obligation hereunder shall not exceed the
amount per OTI set forth in 46 CFR 515.21 or the amount per group
or association of OTIs set forth in 46 CFR 515.21.
The liability of the Insurer shall not be discharged by any
payment or succession of payments hereunder, unless and until such
payment or payments shall aggregate the penalty of the Insurance in
the amount per member OTI set forth in 46 CFR 515.21, or the amount
per group or association of OTIs set forth in 46 CFR 515.21,
regardless of the financial responsibility or lack thereof, or the
solvency or bankruptcy, of Insured. The insurance evidenced by this
undertaking shall be applicable only in relation to incidents
occurring on or after the effective date and before the date
termination of this undertaking becomes effective. The effective
date of this undertaking shall be __ day of __, __, and shall
continue in effect until discharged or terminated as herein
provided. The Insured or the Insurer may at any time terminate the
Insurance by mail or email ([email protected]) written notice to
the Director, Bureau of Certification and Licensing, Federal
Maritime Commission, Washington, DC 20573. Such termination shall
become effective thirty (30) days after receipt of said notice by
the Commission. The Insurer shall not be liable for any
transportation-related activities under the Shipping Act of the
Insured after the expiration of the 30-day period but such
termination shall not affect the liability of the Insured and
Insurer for such activities occurring prior to the date when said
termination becomes effective.
(Name of Agent) __ domiciled in the United States, with offices
located in the United States, at __ is hereby designated as the
Insurer's agent for service of process for the purposes of
enforcing the Insurance certified to herein.
If more than one insurer joins in executing this document, that
action constitutes joint and several liability on the part of the
insurers.
The Insurer will promptly notify the Director, Bureau of
Certification and Licensing, Federal Maritime Commission,
Washington, DC 20573, in writing by mail or email
([email protected]), of all claims made, lawsuits filed, judgments
rendered, and payments made against the Insurance.
Signed and sealed this __ day of __, __.
Signature of Official signing on behalf of Insurer Type Name and
Title of signer
This Insurance Form has been filed with the Federal Maritime
Commission.
[80 FR 68738, Nov. 5, 2015]