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Storage Tank Certificate of Insurance


Form 62-761.900(3) Part D
Also Needed

General Guidance

  • Calculate FR needs, Reference Manuals, EPA link and FAQs
  • DEP Forms must be used and filled out completely
  • Verify current version of form part is used  ("October 2019" version if signed after 10/13/2019)
  • Verify insurance company is registered in Florida - Florida Office of Insurance Regulation 
  • Verify facility and tanks at site have coverage. The following should match the state registration:
    • Facility identification number (FacID) (for facilities in Florida)
    • Facility name
    • Site address
    • Number of regulated tanks (or list of tank identification numbers)
  • Confirm "owner or operator" name is same as in if not a governmental agency or sole proprietor

Form Specific Guidance

  • See "Insurance Checklist" PDF (below) to make sure your documentation is complete and acceptable.
  • ACORD form may not be used as proof of financial responsibility
  • Electronic signatures (for both insurer rep and witness) that follow requirements of ESIGN Act and UETA (and industry best practice standards) are acceptable.
  • Verify date of witness signature is reasonable (either after the start of the period of coverage or shortly before it started).
  • The October 2019 form differs from the January 2017 form in the signature section, but actual requirements have not changed. The current form uses the term "discharges" rather than "releases".

What to Do with Completed Forms

  • An owner or operator must maintain financial responsibility records (the completed form parts with required supporting documentation) at the facility or at their business office.
  • If not kept at the facility, they shall be made available at the facility or another agreed upon location upon five business days notice by a department or county inspector.


  • Sunbiz – verify owner/operator’s legal name (including punctuation and abbreviations)
  • Florida Office of Insurance Regulation – check insurance company licensure
  • Florida CFO website – check agent licensure
  • Guide to Tank Insurance - prepared by Association of State and Territorial Solid Waste Management Officials (ASTSWMO) [see "View Publication"]
  • UST Technical Compendium: Financial Responsibility - EPA
    • Explains unacceptability of voluntary tank removal and voluntary tank site investigation exclusions, self-insured retentions (SIRs), and loading and unloading exclusions. Such unacceptable provisions in a policy are inconsistent with Florida and adopted federal regulations. 
    • This guidance is applicable to both USTs and ASTs.
  • EPA List of Insurance Companies – identifies most storage tank coverage providers
    • Some companies on this list may not be licensed to do business in Florida
  • Uniform Electronic Transactions Act (UETA) - enacted in Florida by SB1334 in 2000

Return to Storage Tank Financial Assurance Forms (Mechanisms) webpage

Form Number: 
62-761.900(3) Part D
Effective-Revision Date: 
Friday, February 7, 2020
Form Instructions: 
Last Modified:
May 19, 2022 - 11:04am

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