We take great care to make sure the financial documents are completed accurately. Feel free to contact us with form or data specific questions when filling financial assurance forms. We recommend completed forms (prior to being signed) be e-mailed to us so that we may verify data accuracy and form completeness. Contact anyone from the list below for assistance.
Check the appropriate box(es) for the “Required Actions” covered by this instrument.
Legal Name of Owner or Operator
The Owner or Operator’s (Permittee) legal company name must exactly match (including abbreviations and punctuation) the name as listed with the Division of Corporations and the company "Status" must be listed as "Active." The exact spelling can be checked at Sunbiz.org. If DEP form requires the Owner or Operator name to be entered multiple times, please copy and paste the exact name in each blank.
Legal Name of Provider Company
Legal name (not trademark or fictitious name) must be used or included. The exact spelling may be checked at FDIC (for most banks), Circular 570 (for all bonds) or Sunbiz.org.
DEP ID Number = EPA ID Number
This is a 12 digit 'number' beginning with "FL." See Facility List for existing facilities.
Facility Name and Site Address
The facility name must match the facility name as stated in the DEP permit application. The site address is the address of the physical location of the facility; this address cannot be a P.O. box.
When a person signing for the owner or operator is not the president of a corporation, managing member of an LLC or equivalent for entity type, a delegation of authority letter may be required. If the president (or equivalent) is not found on the Florida Division of Corporation website (Sunbiz.org), additional documentation will be required. Please sign in blue ink.
Power-of-Attorney: must have required watermark, colored number or border, embossed seal(s), etc., pursuant to the requirements of the Power-of-Attorney document.
Date bond executed: must match power of attorney date.
Liability Limit: A Liability Limit is to be filled in only if more than one Surety shares the liability of this bond. For each additional Surety, create a separate Corporate Surety(ies) section with required information and appropriate signatures, seals and attachments. (For single surety bonds, leave blank or enter "N/A" for not applicable.)
Trust Funds and Standby Trust Funds
Trustee entering into this agreement must be an entity with the authority to act as a Trustee and whose operations are regulated and examined by a federal or state agency.
Most banks with trust powers can be verified with FDIC.
Effective Date (on page 1) is the date the policy originally became effective; it will not change unless a new policy (with a new policy number) is issued. The date the certificate is signed (notary/witness date) is the date any changes to the policy take place associated with this certificate.
Insurer seal: We appreciate the certificate having the embossed seal of the Insurer.
Submission must include three items:
Chief Financial Officer (CFO) Letter (the DEP form)
Auditor's statements from fiscal year end
Auditor's Special Report
must confirm that asterisked items in the CFO letter were accurately derived from the audited financial statements
if Special Report is dated before the CFO’s letter, it must specify the dollar amounts "compared"
Letters of Credit
Cover Letter: This is to be completed by Permittee/Applicant with initial submission of letter of credit.
Dates: The date the credit will automatically renew on (i.e., "Date" [blank] on the third line of paragraph that starts "This letter of credit is effective as of…") must be the same date identified as "Date at Least One Year Later."
This credit is subject to: governing language does not have to exactly match the insert options.
Banks using security paper or bank letterhead containing watermarks, etc., may copy the form’s wording and paste it into their document.
Pasting the exact wording will prevent typographical errors and editorial changes.
Additions, deletions or alterations of the wording are not acceptable other than including only the required “Closure”/”Postclosure”/”Corrective Action” terms (and adding the word “and” if appropriate), replacing blanks with appropriate information, removing the guidance phrases for those blanks, placing the numeric credit amount within parentheses, and removing references to the form (four lines in upper right corner on page 1 and footers that include the form number and page numbers).
If bank policy prevents you from using the required wording, kindly inform your client that you will not be able to meet this financial assurance need.
As errors are common in this process, please let us do a courtesy review before signing.
The Florida Department of Environmental Protection is the state’s lead agency for environmental management and stewardship – protecting our air, water and land. The vision of the Florida Department of Environmental Protection is to create strong community partnerships, safeguard Florida’s natural resources and enhance its ecosystems.