Cal. Code Regs. tit. 23, § 2809.1
(c) An owner or operator using a mechanism allowed by this article must maintain an updated copy of a certification of financial responsibility worded as follows, except that instructions in brackets are to be replaced with the relevant information and the brackets deleted:
CERTIFICATION OF FINANCIAL RESPONSIBILITY
[Owner or operator] hereby certifies that [owner or operator] is in compliance with the requirements of section 2807, article 3, chapter 18, division 3, title 23, California Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by section 2807 are as follows:
[List the facility and address, each 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]
[Signature of owner or operator]
[Name of owner or operator]
[Title]
[Date]
[Signature of witness or notary]
[Name of witness or notary]
[Date]
The owner or operator must update this certification whenever the mechanisms used to demonstrate financial responsibility change.
Note: Authority cited: Section 25299.77, Health and Safety Code. Reference: Sections 25299.31 and 25299.33, Health and Safety Code.
1. New section filed 12-2-91 as an emergency; operative 12-2-91. Text remains in effect uninterrupted pursuant to Health and Safety Code section 25299.77 (Register 92, No. 9).
2. Editorial correction of printing errors in History 1. (Register 92, No. 43).
3. Amendment of section and Note filed 10-27-2000; operative 11-26-2000 (Register 2000, No. 43).