Certification of Financial Responsibility
[Tank system owner or operator] hereby certifies that it is in compliance with the requirements of 6 NYCRR Part 613-8.
The financial assurance mechanism(s) used to demonstrate financial responsibility under 6 NYCRR Part 613-8 is (are) as follows:
[For each mechanism, list the type of mechanism, name of issuer, mechanism number (if applicable), amount of coverage, effective period of coverage and whether the mechanism covers "taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "non-sudden accidental releases" or "accidental releases."]
[Signature of tank system owner or operator]
[Name of tank system owner or operator]
[Title]
[Date]
[Signature of witness or notary]
[Name of witness or notary]
[Date]
N.Y. Comp. Codes R. & Regs. Tit. 6 §§ 613-8.6