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Storage Tank Insurance Endorsement


Form 62-761.900(3) Part C

Other Forms Needed, Examples, and Links

Insurance Specific Guidance

  • ACORD form may not be used as proof of financial responsibility.
  • Verify date of witness signature is reasonable (either after the start of the period of coverage or shortly before it started).

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 Storage Tank Financial Assurance Forms (Mechanisms) webpage.

Form Number: 
62-761.900(3) Part C
Effective-Revision Date: 
Sunday, June 25, 2023
Last Modified:
July 7, 2023 - 9:06am

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