Financial Assurances Forms

Many of the financial assurance demonstration mechanisms are required by regulations to be completed and submitted by use of specified forms. These forms are adopted through the rulemaking process and are available here. In addition, to aid the Financial Assurances Section in responding to requests for reviews and disbursements, standardized forms are available, ensuring complete and consistent information.

• CIWMB 217 Financial Assurance Mechanism Review Request: Adobe PDF, 20 KB | MS Word, 124 KB
• CIWMB 231 Verification of Costs for Disbursement from Financial Mechanism: Adobe PDF, 29 KB | MS Word, 50 KB
• CIWMB 100 Trust Agreement (MS Word, 70 KB)
• CIWMB 101 Irrevocable Letter of Credit (MS Word, 27 KB)
• CIWMB 102(a) Performance Bond for Closure (MS Word, 42 KB)
• CIWMB 102(b) Performance Bond for Postclosure (MS Word, 43 KB)
• CIWMB 102(c) Performance Bond for Corrective Action (MS Word, 44 KB)
• CIWMB 103(a) Financial Guarantee Bond for Closure Costs (MS Word, 85 KB)
• CIWMB 103(b) Financial Guarantee Bond for Postclosure Costs (MS Word, 85 KB)
• CIWMB 103(c) Financial Guarantee Bond for Corrective Action Costs (MS Word, 85 KB)
• CIWMB 104 Letter from the Chief Financial Officer Financial Means Test for Postclosure Maintenance and/or Operating Liability (MS Word, 46 KB)
• CIWMB 105 Guarantee (MS Word, 32 KB)
• CIWMB 106 Certificate of Insurance for Closure/Postclosure Maintenance Reasonably Foreseeable Corrective Action (MS Word, 43 KB)
• CIWMB 107 Certificate of Liability Insurance (MS Word, 39 KB)
• CIWMB 108 Liability Insurance Endorsement (MS Word, 39 KB)
• CIWMB 109 Certificate of Self-Insurance and Risk Management (MS Word, 36 KB)
• CIWMB 110 Operator Certification of Comprehensive General Liability Insurance Coverage and Establishment and Funding of the Environmental Liability Fund (MS Word, 27 KB)
• CIWMB 111 Environmental Liability Fund Agreement (MS Word, 66 KB)
• CIWMB 112 Letter From the Chief Financial Officer Means Test for Postclosure Maintenance and/or Operating Liability (MS Word, 99 KB | Adobe PDF, 61 KB)
• CIWMB 113 Guarantee for Postclosure Maintenance and/or Corrective Action (MS Word, 104 KB | Adobe PDF, 46 KB)