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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.

Form Number: 
Effective-Revision Date: 
Wednesday, August 15, 2018
Last Modified:
January 16, 2024 - 10:19am

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