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Storage Tank Financial Test (Self Insurance)


Form 62-731.900(3) Part A

Other Forms Needed, Examples, and Links

Financial Test Specific Guidance

  • The Chief Financial Officer (CFO) may have a title different from "CFO", such as Comptroller, Vice President of Finance, Treasurer, etc. but the CFO title is unlikely to include the word "assistant". Other individuals may have the authority to sign, but they will be able to produce documentation demonstrating their authorization.
  • Period of Coverage: 1st day of fiscal year to 180 days after fiscal year end for government entities and 120 days after fiscal year end for private companies.
  • Check Independent CPA's special report when required by Alternate II line 19 (often called an Agreed Upon Procedures Report)
Alternative I Alternative II
  • Lines 7 and 8 must be "YES". 
  • Lines 9 – 12:  at least one must be “YES”
  • Lines 8 and 9 must be “YES”. 
  • If Line 10 is "NO" then complete Line 11 (Line 11 must be "YES"). 
  • Complete either Lines 12 - 15 or Lines 16 - 18
    • Lines 12 - 15 Line 15 must be "Yes"
    • Lines 16 - 18  Either a Standard & Poor's rating of BBB or better or Moody's rating of Baa or better
  • If Line 19 is answered "NO," a Special Report is needed 

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 A
Effective-Revision Date: 
Sunday, June 25, 2023
Last Modified:
July 7, 2023 - 9:06am

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