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Storage Tank Certification of Financial Responsibility

Form 62-761.900(3) Part P

Other Forms Needed, Examples, and Links

Certification of Financial Responsibility Specific Guidance

  • This form part is completed by the owner or operator.
    • The owner or operator certifies all financial responsibility requirements are being met.
    • It acts as a cover letter for the utilized financial assurance mechanism(s).
  • "Owner or Operator" name must
    • match the name on mechanism(s),
    • be a legal entity (company name as registered with Divisions of Corporations),  government agency or sole proprietor),
    • be one or more of the following:  facility owner, tank owner, facility operator or tank operator.
  • Primary mechanisms include Insurance, Guarantees, Bonds, Letters of Credit and funded Trust Funds.   Financial Tests, Bond Tests and Government Funds are also a primary mechanism if not part of a guarantee. 
  • "Name of Provider (issuing institution)" means the legal entity name of the company providing the insurance, bond or guarantee, etc. 
    • Enter "self" if the owner or operator is providing a Financial Test or is using only a Fund or Bond Test. 
    • If using a Guarantee, enter the Guarantor's name.
  • "Instrument No." is applicable for the following instruments:
    • Insurance Endorsement (Part C) - policy number
    • Certificate of Insurance (Part D) - policy number
    • Performance Bond (Part E) - surety bond number
    • Letter of Credit (Part F) - letter of credit number
    • Trust Fund Agreement (Part G) - account number
  • The Period of Coverage is determined by the financial assurance document used - check the specific guidance for the relevant form part.
  • Complete the boxed section (Standby Trust Fund, etc.) when a bond, letter of credit or Guarantee (Form Parts B, K, L or N) is used.
    • Note: a Guarantee will be the primary mechanism and the supporting (if required) test or fund information will go in the boxed section.
      • The period of coverage for a guarantee will be the period of coverage of the utilized supporting instrument (Part A, I, J or O).
      • The period of coverage for guarantees by a state (Parts M and N) is from signing date to "evergreen".
  • Note: the C.F.R. no longer requires a list of facilities as those facilities are listed on the referenced instrument(s).
  • As long as the mechanism(s) remain unchanged and current (dates of coverage, facilities covered etc.), this C.F.R. (Part P) will remain current.
    • A Trust Fund (Part G) balance will change with income and expenses, so a C.F.R. is required annually.

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.

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

Form Number: 
62-761.900(3) Part P
Effective-Revision Date: 
Sunday, June 25, 2023
Last Modified:
January 22, 2024 - 3:04pm

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