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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:

  1. Trust Fund (Part G),
  2. Standby Trust Fund (Part H),
  3. State Government Guarantee w/out standby Trust fund (Part M) or  
  4. 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), and the other guarantees (Part I, J K, or L).

See 40 CFR 280.112 for details. 

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

Form Number: 
Effective-Revision Date: 
Wednesday, August 15, 2018
Last Modified:
October 1, 2020 - 4:47pm

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