CG 5585 Application for Vessel Certificate of Financial Responsi

Approved OMB No. 1625-0046
(Expires 09-06)

DEPARTMENT OF HOMELAND SECURITY
U.S. COAST GUARD
CG-5585

APPLICATION FOR VESSEL CERTIFICATE OF
FINANCIAL RESPONSIBILITY (WATER POLLUTION)
1. (a) Legal name of applicant (name of responsible operator of all vessels listed in Part II):

(b) English equivalent of legal name if customarily written in language other than English:

GENERAL
(PART 1 OF 4 PARTS)
INSTRUCTIONS
Please type or print and submit this application to
Director, Coast Guard National Pollution Funds
Center (Cv), 4200 Wilson Boulevard, Suite 1000,
Arlington, VA 22203-1804. Applicants must answer
all applicable questions. If a question does not
apply, answer "not applicable." Incomplete
applications will be returned. If additional space is
required, supplemental sheets may be attached.
All information must be provided in the English
language. As an alternative to using this form,
you may use the E-COFR system, available through
the NPFC's Web site at www.uscg.mil/npfc.

THIS SPACE FOR USE BY USCG ONLY

(c) Trade name, if any

2. Is this the first time the above-named applicant is submitting application Form CG-5585?

YES

NO

If NO, what Coast Guard control number was assigned to the first application Form
CG-5585?

3. State applicant's legal form of organization, i.e., whether operating as an individual, corporation, partnership, association, joint stock company,
business trust, or other organized group of persons (whether incorporated or not) or as a receiver, trustee, or other liquidating agent and briefly
describe current business activities and length of time engaged therein.

(a) If a corporation, association, or other organization, indicate:
State in the United States, or foreign country, in which incorporated or organized:

Date of incorporation or organization:

(b) If a partnership, provide name and address of each partner.

4. Name and address of applicant's United States agent or other person authorized by applicant to accept service of process and receipt of notices of
designations and presentations of claims in the United States (collectively referred to as "service of process"). (See Part IV) (U.S. applicants may
appoint themselves as agent, eliminating the need to complete Part IV.)

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for completing this form is 30 minutes. You may submit any comments concerning the accuracy of this
burden estimate or any suggestion for reducing the burden to the: Commandant (NPFC), U.S. Coast Guard, 2100 2nd Street, SW, Washington,
DC 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0046), Washington, DC 20503.

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Reverse of CG 5585

EVIDENCE OF FINANCIAL RESPONSIBILITY (PART II OF 4 PARTS)
5.

List all vessels which require Certificates of Financial Responsibility under 33 CFR 138.12. In column (f) indicate the number "1" if the operator
is also the registered owner. Indicate "2" in column (f) if the operator is not the registered owner.

NAME OF VESSEL
(a)

TYPE OF
VESSEL
(See note
below)
(b)

COUNTRY
OF
REGISTRY
(c)

US VESSELS: Documentation
Number FOREIGN VESSELS:
International Maritime Orgainzation
(IMO) Number or Country of
Registration Number if no IMO
number has been assigned.
(d)

GROSS
TONS

"1"
OR
"2"

(e)

(f)

NOTE: Please designate the type of vessel by using a number from one of the following categories:
CARGO VESSELS, SELF-PROPELLED
Breakbulk freighter 10
Containership * 11
Roll on-roll off 12
Barge carrier (e.g., lash, seabee) 13
Combination breakbulk containership * 14
Combination roll on-roll off containership * 15
Combination barge carrier containership * 16
Tanker 17
Dry bulk carrier 18
All other self-propelled cargo vessels 19
Oil/bulk/ore carrier (OBO) 20

PASSENGER VESSELS
Passenger vessel * * 30
Combination passenger/cargo
vessel * * 31
Ferry * * 32
RECREATIONAL VESSELS
All types of pleasure craft 40

UTILITY CRAFT
Tank barge 50
Tug and towboat 51
Barge and scow 52
Drilling rig 53
Fishing vessel 54
Factory vessel 55
Research vessel 56
All other utility craft*** 57
MISCELLANEOUS
Vessels not otherwise
specified 60

* Containership categories should be assigned only to vessels having fixed container cells or regularly carrying multi-tier container
deckloads.
** Passenger categories should be assigned only to vessels carrying more than 12 passengers for hire.
*** Includes floating cranes, dredges, docs, etc.
5. (g) if applicant indicated "2" for any vessel listed above-in column 5(f), please indicate:
NAME OF VESSEL

OWNER

OWNER'S MAILING ADDRESS

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PART II (CONT'D)
6.

Items 7 through 11 are methods of establishing financial responsibility. Check the appropriate box(es) below and answer only the item(s) which are
applicable to this application:

Insurance
(Answer item 7)

Surety Bond
(Answer item 8)

Financial Guaranty
(Answer item 9)

Self-Insurance
(Answer item 10)

Other Services
(Answer item 11)

7. Name and address of applicant's insurance guarantor (evidence of insurance acceptable to the Director, Coast Guard National Pollution Funds
Center on Insurance Guaranty Form CG-5586 or Master Insurance Guaranty Form CG-5586-1, must be filed before a Certificate will be issued):

8. Total amount of surety bond guaranty.

$
Name and address of applicant's surety bond guarantor (Surety Bond Guaranty Form CG-5586-2 must be filed before
a Certificate will be issued):

9. Name and address of applicant's financial guarantor (Financial Guaranty Form CG-5585-3, or Master Financial
Guaranty Form CG-5586-4 and all required financial data must be filed before a Certificate will be issued):

Financial Guarantor's fiscal year.
(Month)

(Day)

to

(Month)

(Day)

10. If applicant intends to qualify as a self-insurer attach all required financial data and indicate fiscal year.

(Month)

(Day)

to

(Month)

(Day)

11. If applicant intends to qualify through other evidence, supply all information required by 33 CFR 138.80(b)(5).

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DECLARATION (PART III OF 4 PARTS)
12. Applicant's mailing address (street, number, post office box,
city, state or country. Indicate ZIP code if in the United
States):

14. Type or print in this space the name and title of the official who is signing the
application:

15. Address of principal office in the United States (if any):

13. Telefax number and/or telex number and answerback:

16. Telephone no. (area code and number):

I declare that I have examined this application, including any accompanying schedules and statements, and, to the best of my knowledge and belief, it is
true, correct, and complete. Furthermore, the applicant named in item 1(a) of Part 1 above is the responsible operator of all vessels now listed in or later
added to this application. I agree that in the event the agent designated in item 4 of Part 1 above, or that agent's replacement as may be designated later with
the approval of the Director, Coast Guard National Pollution Funds Center, cannot be served due to death, disability, unavailability, or similar event, the
Director, Coast Guard National Pollution Funds Center, is considered the agent for service of process. I have signed this application in my capacity as an
authorized official of the applicant, or, if acting under a power of attorney, pursuant to the power vested in me by the applicant as evidenced by the attached
power of attorney.

IMPORTANT

DATE

NOTE

SIGNATURE OF AUTHORIZED OFFICIAL

Please be sure that Parts I, II, and III have been completed in full and that Part III has been dated and signed. Then proceed to Part IV, attached.

NO CERTIFICATE WILL BE ISSUED UNLESS A COMPLETED APPLICATION
FORM HAS BEEN RECEIVED, PROCESSED AND APPROVED.
COMMENTS

Any person who knowingly and willfully makes a false statement in this application is subject to the sanctions prescribed in 18 U.S.C. 1001

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CONCURRENCE OF AGENT (PART IV OF 4 PARTS)
PART IV- A must be completed by the person designated in item 4 of Part 1 to serve as applicant's United States agent for service of process.
Part IV-B must be completed by the applicant. After Parts IV-A and IV-B are completed, Part IV should be submitted to the Director, Coast Guard
National Pollution Funds Center, by the applicant or by the agent, either separately or together with Parts I, II, and III. (Part IV need not be
completed if the agent designated in item IV of Part I already has submitted to the U.S. Coast Guard an acceptable blanket Concurrence of Agent,
agreeing to serve on behalf of certain applicants who designate that agent. Part IV also need not be completed if the applicant is a United States
entity and has appointed itself as agent in item 4 of Part I.)

PART IV-A
It is hereby agreed that
shall serve as the applicant's United States agent for service of process for purposes of 33 CFR part 138. This designation and agreement
shall cease immediately in the event the applicant designates a new agent acceptable to the Director, National Pollution Funds Center.
Date:

Signature of person signing on behalf of agent:
Title:
Business address:

PART IV-B (TO BE COMPLETED BY APPLICANT)
Name of applicant (from item 1(a)):

Signature of authorized official signing on behalf of applicant
(Person signing here should also sign in
appropriate place on Part III)
Date:

Type or Print Name and Title:

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Department of
Homeland Security
United States
Coast Guard

Director
United States Coast Guard(cv)
National Pollution Funds Center
WEBSITE:

4200 Wilson Blvd
Suite 1000
Arlington, VA 22203

www.npfc.gov/cofr

Phone: 202/493-6780
Fax:
202/493-6781

Please find the document(s) requested;
Form CG-5585; Application for Certificate of Financial Responsibility, which may be reproduced
Persons who intend to apply for Certificates of Financial Responsibility (Water Pollution) are urged to read 33 CFR Part 138 carefully
and complete application Form CG-5585 in full, so that delays in processing may be avoided. Only "operators" as defined in 33 CFR
section 138.20(b) may apply for Certificates and only one copy of the application form is necessary, regardless of the number of
vessels operated by the applicant. Applications should be filed at least 21 days prior to the date the Certificate is required.
First-time applications are subject to an application fee of $150 (an additional application fee is not required when renewing or adding
vessels, either by letter or supplementary application forms, to the original application at later dates). In addition, each requested
Certificate is subject to a certification fee of $80. Fees may be submitted by check, draft, or postal money order in United States
currency and must be made payable to the United States Coast Guard. The application may be faxed for initial submission.
In order to qualify for one or more Certificates, an applicant must demonstrate financial ability to pay "removal costs" which could
result from a discharge of oil or hazardous substances caused by any one of the vessels for which the applicant desires Certificates.
Acceptable methods of establishing evidence of financial responsibility (e.g., Insurance Form CG-5586) are set forth in 33 CFR section
138.80(b). Insurance, guaranty, and surety bond coverage on USCG forms will be accepted only if executed by insurers, guarantors or
sureties holding USCG approval. Certificates cannot be issued unless a properly completed application form, acceptable evidence of
financial responsibility and fees are submitted.
No vessel over 300 gross tons (except "public vessels" (33 CFR section 138.12(d)/138.20) and nonself-propelled barges which do not
carry oil or hazardous substances as cargo or fuel, including fuel carried for the purpose of powering on board equipment or for any
other purpose) may use the navigable waters of the United States for any purposes unless it carries a Certificate of Financial
Responsibility (Water Pollution) covering such vessel. The "United States" includes Puerto Rico, the Northern Marianas, Guam,
American Samoa, the U.S. Virgin Islands, and the Trust territory of the Pacific Islands. The "navigable waters" of the United States
include inland waters and the three-mile territorial sea.
An operator may apply in advance for Certificates covering vessels which might be using United States waters at some future time.
Obtaining Certificates in advance for such vessels would relieve the operator of the possibility of delay or detainment until a
Certificate was obtained from the Coast Guard.
If an operator who already holds Certificates becomes or intends to become the operator of additional vessels at some future time,
and he wishes to have such additional vessels certified, he should write to this office giving the following information with respect to
each such vessel: (1) type of vessel, by code number listed in Form CG-5585, item 5; (2) name and gross tons of the vessel; (3)
country of registry, IMO number or registration number; and (4) the name and mailing address of the legally responsible operator
and the registered owner. In the alternative, an application Form CG-5585 may be submitted with a letter explaining the purpose of
such supplemental application form. Any such additional vessel must be covered by evidence of financial responsibility. A
certification fee of $80 per vessel also must be submitted.
Persons who have any questions concerning the enclosed material should write or telephone the National Pollution Funds Center's
Vessel Certification Division (NPFC-cv) in Arlington, Virginia. All submissions of documents must be made directly to this office at the
address above.
Regards,
U.S. Coast Guard, Vessel Certification

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