Natural Person

SELF-INSURANCE CERTIFICATE (BASED ON NET WORTH)

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.

The department will require proof of an individuals unencumbered net worth by proof of bank statements and appraisals of other assets.

A Natural Person is defined as an individual, a living human being.

Individual – Filing Requirements

1. A notarized copy of the Statement of Net Worth completed in its entirety (balance sheet indicating assets and liabilities) showing a net unencumbered worth of at least $40,000,form attached.
   • Applicant’s signature must be affixed on the financial statement and notarized. If the certificate is to be issued in two names, both must sign and have notarized.
   • Do not include your homestead or place of residence since they cannot be levied upon in the event of a motor vehicle crash loss.
   • If you include real estate property, it will be necessary to furnish your current tax receipt issued by your local Tax Assessor’s office, which will indicate the value of the property.
   • If assets and liabilities in banks or lending institutions are listed, the name and address of the institution(s) must be listed, and a bank statement must be provided.
2. If the certificate holders possess a Florida driver license provide the driver license number and social security number of the certificate holder(s). If the certificate holders do not possess a Florida driver license number provide the social security numbers.
3. A list by make, model, year, vehicle identification and tag number of the vehicles owned by the certificate holder(s). Only vehicles registered in the state of Florida can be covered.
4. If a vehicle that the certificate holder is requesting to be covered is not registered in their name, the request for self-insurance will be denied.
   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, must be reported within 30 days of such change. A list of additional vehicles must be accompanied by an updated Statement of Net Worth 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. A certificate of self-insurance is valid for a period of one year from the effective date of the certificate.
7. When submitting your request via email, we encourage the documentation to be provided as a PDF.
8. At the time of renewal, if the applicant is requesting a vehicle to be self-insured that is not registered in their name a Letter of Intent will be provided to allow the applicant 30 days to obtain a registration in their name. This letter will need to be provided to the Tax Collector’s office that is processing the registration transaction. Once the vehicle is registered, please contact our office to have the self-insurance certificate updated with the vehicle.