Firm, Partnership, Association or Corporation

The certificate of self-insurance issued by this department as per section 324.171, Florida Statutes, provides limits of liability insurance in the amount of 10/20/10 ($10,000 of bodily injury to, or death of, one person in any one crash, $20,000 of bodily injury to, or death of, two or more persons in any one crash, $10,000 of injury to, or destruction of, property of others in any one crash) and personal injury protection coverage as per section 627.733(3)(b), F.S.

1. Any firm, partnership, association, corporation, other than a natural person – Filing Requirements
   1. A certified copy of a financial statement audited by an independent certified public accountant (balance sheet indicating assets and liabilities) showing a net unencumbered worth for either of the two options listed below:
      1. $40,000 for the first vehicle and $20,000 for each vehicle thereafter (no excess liability insurance required), or
      2. $40,000 net unencumbered worth for the first motor vehicle plus an additional amount of net unencumbered worth for each additional vehicle, to be formulated annually by the Department of Highway Safety and Motor Vehicles based upon actuarial data from property and casualty insurance companies (See, FL Administrative Code 15A-3.011(1)(b)2. The Manual of Financial Responsibility Rates referred to in the rule may be obtained from the Office of Insurance Regulation.) This option is available provided the applicant submits an excess liability insurance policy issued by an authorized or eligible insurer licensed or approved by the Florida Office of Insurance Regulation in the amount of $25,000, $50,000, or $100,000 combined single limits, for each covered vehicle. A financial statement, based on the cost method, which includes depreciation and all liabilities including such liabilities as a note or other liability is collateralized by a specific asset, provide a schedule showing the cost, the amount of depreciation, and the amount of the liability for that asset. Do not include any asset not owned by the company. You may be asked to provide proof that the corporation owns the assets listed. A schedule of the liquidation value (the amount of money which could be obtained by converting the asset in question into cash as of the date of the schedule) of all assets listed in your financial statement submitted at the time of your application for the certificate of self-insurance.
   2. Provide the Federal Employer Identification Number of the certificate holder.
   3. A list by make, model, year, vehicle identification and tag number of the vehicles owned by the certificate holder. This list may be submitted electronically in a spreadsheet format or on a CD. Only vehicles registered or licensed in the state of Florida can be covered.
   4. A certificate of self-insurance as per section 324.171, F.S., only covers vehicles that are registered or leased (under a lease-purchase agreement) by the name(s) listed on the certificate. Any other use of this certificate, such as extending coverage to vehicles that are not registered or leased (under a lease-purchase agreement) by the self-insurer, may subject them to penalties under the Florida Insurance Code for unauthorized insurance practices.
   5. Any change in the vehicles listed, or addition of vehicles to be covered, must be reported within 30 days of such change. A list of additional vehicles must be accompanied by an updated financial statement audited by an independent certified public accountant showing a net unencumbered worth as required by section 324.171, F.S., for all vehicles to be covered. Failure to make such report will result in the cancellation of the certificate of self-insurance.
   6. Proof that the corporation is in active status with the Office of the Secretary of State.
   7. A certificate of self-insurance is valid for a period of one year from the effective date of the certificate.
2. Commercial Motor Vehicle – Filing Requirements

Gross Vehicle Weight Minimum Liability Insurance Required Per Occurrence

If your vehicle or operations are subject to 49 CFR 387 subpart A, then you must provide us proof that you are authorized under the Federal Motor Carrier Safety Administration to self-insure.

1. The owner of a commercial motor vehicle, in order to qualify as self-insured, shall furnish the Department of Highway Safety and Motor Vehicles a certified copy of a financial statement audited by an independent certified public accountant (balance sheet indicating assets and liabilities) showing a net unencumbered worth of either of the options listed below:

If no excess liability insurance is provided:

1. 1. 1. 1. $50,000 for the first vehicle in Category I, and $20,000 for each vehicle thereafter.
         2. $100,000 for the first vehicle in Category II, and $20,000 for each vehicle thereafter.
         3. $300,000 for the first vehicle in Category III, and $20,000 for each vehicle thereafter.
         4. $750,000 for the first vehicle in Category IV, and $20,000 for each vehicle thereafter.

1. 1. Utilizing $50,000, $100,000, $300,000, or $750,000 (whichever is applicable to the gross vehicle weight) net unencumbered worth for the first motor vehicle plus an additional amount of net unencumbered worth for each additional vehicle, to be formulated annually by the Department of Highway Safety and Motor Vehicles based upon actuarial data from property and casualty insurance companies (See , FL Administrative Code 15A-3.011(1)(c)1.b. The Manual of Financial Responsibility Rates referred to in the rule may be obtained from the Office of Insurance Regulation.) This option is available provided the applicant submits an excess liability insurance policy issued by an authorized or eligible insurer licensed or approved by the Florida Office of Insurance Regulation in the amount of $50,000, $100,000, $300,000, or $750,000 combined single limits, for each covered vehicle (whichever is applicable based upon the weight of the vehicle). A financial statement, based on the cost method, which includes depreciation and all liabilities including such liabilities as a note or other liability is collateralized by a specific asset, provide a schedule showing the cost, the amount of depreciation, and the amount of the liability for that asset. Do not include any asset not owned by the company. You may be asked to provide proof that the corporation owns the assets listed. A schedule of the liquidation value (the amount of money which could be obtained by converting the asset in question into cash as of the date of the schedule) of all assets listed in your financial statement submitted at the time of your application for the certificate of self-insurance.

2. Provide the Federal Employer Identification Number of the certificate holder.
3. A list by make, model, year, vehicle identification and tag number of the vehicles owned by the certificate holder by GVW class. This list may be submitted electronically in a spreadsheet format or on a CD. Only vehicles registered or licensed in the state of Florida can be covered.
4. A certificate of self-insurance as per section 324.171, F.S., only covers vehicles that are registered or leased (under a lease-purchase agreement) by the name(s) listed on the certificate. Any other use of this certificate, such as extending coverage to vehicles that are not registered or leased (under a lease-purchase agreement) by the self-insurer, may subject them to penalties under the Florida Insurance Code for unauthorized insurance practices.
5. Any change in the vehicles listed, or addition of vehicles to be covered, must be reported within 30 days of such change. A list of additional vehicles must be accompanied by an updated financial statement audited by an independent certified public accountant showing a net unencumbered worth as required by section 324.171, F.S., for all vehicles to be covered. Failure to make such report will result in the cancellation of the certificate of self-insurance.
6. Proof that the corporation is in active status with the Office of the Secretary of State.
7. A certificate of self-insurance is valid for a period of one year from the effective date of the certificate.
8. When submitting your request via email, we encourage the documentation to be provided as a PDF.