Form MA-1060 Form MA-1060 Voluntary Tanker Agreement

Form Approved: 6/18/2007

OMB No. 2133-0505

U.S. Department

of Transportation

Maritime

Administration

This collection of information will be used to fulfill the requirements of 50 App. U.S.C. 2158 regarding the application to participate in the Maritime Administration's (MARAD) Voluntary Tanker Agreement (VTA) program. Response to this information collection is strictly voluntary. The public reporting burden of this collection is estimated to average 5 hours per response. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently approved OMB control number. The OMB control number for this collection is 2133-0505. Send comments regarding this burden estimate or any other aspect of this collection to MARAD, Office of Management and Administrative Services, 1200 New Jersey Avenue, S.E., Washington, D.C. 20590.

Instructions for Enrollment in the

Voluntary Tanker Agreement (VTA) Program

Part I. Application to participate in the VTA:

Submit two (2) originals of the VTA application. Upon approval, one of the original applications will be returned to you and the other will be retained by the Maritime Administration (MARAD). If applicant does not have a corporate seal, the application must be notarized.

Part II. VTA Application Worksheet:

The information requested in the VTA worksheet is needed by MARAD to assess your eligibility for participation in the VTA program and to process your application. Please fill in all requested items, as applicable, and attach appropriate documentation where requested.

Part III. VTA Spreadsheet:

• Vessel Name - self explanatory

• Vessel Type - self explanatory (product, crude, ITB crude)

• Vessel Speed - self explanatory

• Program Type (Most typical of the vessel, i.e. Jones, MSP, international trade). If multiple entries apply, please indicate by footnote.

• DWT - total deadweight (CARRIER INPUT ON CARGO DWT IS NEEDED)

Form MA-1060 (6/2008) Page 1 of 6

Part I

Form Approved: 6/18/2007

OMB No. 2133-0505

U.S. Department

of Transportation

Maritime

Administration

Application to Participate in the

Voluntary Tanker Agreement

The Applicant identified below hereby applies to participate in the Maritime Administration’s agreement entitled “Voluntary Tanker Agreement.” The text of said Agreement is published in Federal Register, Vol. _____, No. _____, Pages _____________, Date ___________. This Agreement is authorized under Section 708 of the Defense Production Act of 1950, as amended (50 App. U.S.C. 2158). Regulations governing this Agreement appear at 44 CFR Part 332 and are reflected at 49 CFR Subtitle A.

The Applicant, if selected, hereby acknowledges and agrees to the incorporation by reference into this Application and Agreement of the entire text of the Voluntary Tanker Agreement published in Federal Register, Vol. _____, No. _____, Pages _____________, Date ___________, as though said text were physically recited herein.

The Applicant, as a Participant, agrees to comply with the provisions of Section 708 of the Defense Production Act of 1950, as amended, the regulations of 44 CFR Part 332 and as reflected at 49 CFR Subtitle A, and the terms of the Voluntary Tanker Agreement. Further, the Applicant, if selected as a Participant, hereby agrees to contractually commit to make specifically enrolled vessels or capacity available for use by the Department of Defense and to other Participants as described in this Agreement.

Attest:

_____________________________ ______________________________

(Corporate Secretary) (Applicant-Corporate Name)

______________________________

(Name, please print)

(CORPORATE SEAL or Notary) By: ______________________________

(Signature)

______________________________

(Position Title, please print)

Effective Date: _____________

UNITED STATES OF AMERICA

DEPARTMENT OF TRANSPORTATION MARITIME ADMINISTRATION

_____________________________ By: ______________________________

(Secretary) Maritime Administrator

(SEAL)

Form MA-1060 (6/2008) Page 2 of 6

Part II

Form Approved: 6/18/2007

OMB No. 2133-0505

U.S. Department

of Transportation

Maritime

Administration

Voluntary Tanker Agreement (VTA) Application

Worksheet

(1) Name of Applicant and address of principal executive office

(2) Ownership of Applicant:

Are you a U.S. company that owns, operates or charters tankers and ocean-going tugs and tank barges?

(yes) (no)

(3) Do you control the vessel(s) through ownership or as the bareboat charterer? ( ) Yes ( ) No If you are the bareboat charterer, please provide a bareboat charter agreement between you and the owner of the vessel(s).

(4) (a) Are you a subsidiary of a foreign owned company or do you own foreign subsidiaries? ( )Yes ( )No

If yes, list below or on a separate sheet of paper. Please describe the ownership arrangements with particular detail to how these arrangements affect the provision of assured access to vessels by the U.S. Government.

2. In addition, list any affiliated companies.

Form MA-1060 (6/2008) Page 3 of 6

Part II – Continued

Form Approved: 6/18/2007

OMB No. 2133-0505

(5) Are all of these vessels capable of ocean service, including transoceanic voyages? ( ) Yes ( ) No

(6) Please provide vessel information on the VTA Spreadsheet. This Spreadsheet may be copied for additional entries.

Please complete the following information for your company:

_________________________________________

Name and Title of Company Official

(Print or type)

_________________________________________ _____________

Signature of Company Official Date

Phone: __________________________________

Fax: ____________________________________

E-mail: _________________________________

Point of Contact if other than company official:

Phone: __________________________________

Fax: ____________________________________

E-mail: _________________________________

Form MA-1060 (6/2008) Page 4 of 6

Part III

Form Approved: 6/18/2007 OMB No. 2133-0505

SAMPLE

U.S. Department

of Transportation

ABC Carriers, Inc.

Company Name

Maritime

Administration

Vessel

IMO

Operating

Program

Vessel

Cargo

Vessel Name

Vessel Type

Number

Flag

Year Built

Speed

Type

DWT

DWT

VTA SHIPS

ABC VESSEL

Crude Carrier

8989674

U.S.

1985

16

Jones Act

80,000

50,000

XYZ VESSEL

Product Tanker

7858098

Liberia

1990

17

International

40,000

30,000

EFG VESSEL

ITB

9878787

U.S.

2000

22

MSP

60,000

45,000

Totals

VTA SPREADSHEET AGREED TO BY:

Print Name & Title of Company Official

Signature of Company Official

Date

For vessel speed please provide normal operating speed

Form MA-1060 (6/2008)

Page 5 of 6

Part III

Form Approved: 6/18/2007 OMB No. 2133-0505

U.S. Department

of Transportation

Company Name

Maritime

Administration

Vessel

IMO

Operating

Program

Vessel

Cargo

Vessel Name

Vessel Type

Number

Flag

Year Built

Speed

Type

DWT

DWT

VTA SHIPS

Totals

VTA SPREADSHEET AGREED TO BY:

Print Name & Title of Company Official

Signature of Company Official

Date

For vessel speed please provide normal operating speed

Form MA-1060 (6/2008)

Page 6 of 6