Certificate of Valid Claim (example)

This form is an example that may be used. This is not an official DEP form, but was created for your convenience; it is based on the federal code's wording.

The Certificate of Valid Claim is one way to make a third-party liability claim when the utilized financial responsibility mechanisms include:

• Trust Fund (Part G),
• Standby Trust Fund (Part H),
• State Government Guarantee w/out standby Trust fund (Part M) or  
• Local Government Guarantee w/out standby Trust fund (Part N). 

The following instruments require the use of a standby trust fund agreement:

• bond (Part E)
• letter of credit (Part F)
• the other guarantees (Part I, J K, or L).

See 40 CFR 280.112 for details on the "Certification of Valid Claim."

Go to the Storage Tank Financial Assurance Forms (Mechanisms) webpage.