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BUREAU OF MOTORIST COMPLIANCE
INSTRUCTIONS FOR MOTOR VEHICLE
SELF-INSURANCE/FINANCIAL RESPONSIBILITY CERTIFICATION

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INSTRUCTIONS FOR MOTOR VEHICLE
SELF-INSURANCE/FINANCIAL RESPONSIBILITY CERTIFICATION

METHOD I - SELF-INSURANCE CERTIFICATE (BASED ON NET WORTH)

The certificate of self-insurance issued by this department as per section 324.171, Florida Statutes, provides $300,000 combined limits of liability insurance on a per-occurrence basis (section 324.032, F.S.). The certificate holder must operate at least 300 taxicabs, limousines, jitneys, or any other for-hire passenger transportation vehicles.

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 of:
  1. $300,000 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. The applicant must also submit an excess liability insurance policy issued by an authorized or eligible insurer licensed or approved by the Florida Department of Financial Services in the amount of $300,000 combined single limits, for each covered vehicle.

  2. 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.

  3. 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.
  1. Provide the Federal Employer Identification Number of the certificate holder.


  2. A list by make, model, year, vehicle identification and tag number of the vehicles owned by the certificate holder. Only vehicles registered or licensed in the state of Florida can be covered.
    “Ownership” is defined in section 324.021(9)(a), F.S., as “owner” – A person who holds the legal title of a motor vehicle; or, in the event a motor vehicle is the subject of an agreement for the conditional sale or lease thereof with the right of purchase upon performance of the conditions stated in the agreement and with an immediate right of possession vested in the conditional vendee or lessee, or in the event a mortgagor of a vehicle is entitled to possession, then such conditional vendee or lessee or mortgagor shall be deemed the owner for the purpose of this chapter.
    A certificate of self-insurance as per section 324.171, F.S., only covers vehicles that are owned 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 owned 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.

    Any change in the ownership of 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 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.


  3. A list of all officers, directors, and stockholders owning 10 percent or more of the stock of the corporation.
  4. “Stockholder” is defined as the ownership of stock held by a single individual or the individual and his family which includes only his brothers and sisters (whether by whole or half blood), spouse, ancestors, and lineal descendants. Stockholder also includes ownership of stock in the same corporation owned, directly or indirectly, by his partner. In the case of a corporate or partnership stockholder, the stockholder is the natural person owning 10 percent or more stock of the corporate stockholder (apply the definition of stockholder above) or owning 10 percent or more of the partnership stockholder.
  5. A certified copy of certificate holder’s Articles of Incorporation.


  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. Not less than 30 days prior to the expiration date of the certificate, the department shall request an audited financial statement specifying the net unencumbered worth of the self-insurance holder, an insurance update specifying excess liability insurance coverage and a current list of vehicles for the purpose of renewing the certificate.

NOTE: Should you have any questions regarding these requirements, please submit an email to the following email address:

selfinsurance@flhsmv.gov
Fax Number: (850) 617-3938


Mailing Address: Bureau of Motorist Compliance
Neil Kirkman Building
2900 Apalachee Parkway
Tallahassee, Florida 32399-0585

Attention: Self Insurance


Email Address: selfinsurance@flhsmv.gov




Revised 06/2013



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