Form MMS-1020 Surety Bond

U.S. Department of the Interior OBM Control No. 1010-0106

Bureau of Ocean Energy Management, OMB Approval Expires: xx/xx/xxxx

Regulation and Enforcement

SURETY BOND

OIL POLLUTION ACT OF 1990 APPLICATION FOR CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY

(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. DESIGNATED APPLICANT: ______________________________________________________ ___________________________

COMPANY LEGAL NAME BOEMRE COMPANY NUMBER

2. SURETY COMPANY BOND NUMBER: ________________________________________

3. KNOW ALL MEN BY THESE PRESENTS, that we, ___________________________________________________,

DESIGNATED APPLICANT

of __________________U.S.A., as Designated Applicant (hereinafter called Principal), and ___________________

STATE OF INCORPORATION SURETY COMPANY

a company created under the laws of _____________, and authorized to do business in the United States, as Surety

STATE

(hereinafter called Surety), and are held and firmly bound unto the United States of America and other claimants for damages and removal cost liability under Title I of the Oil Pollution Act of 1990 (hereinafter called Act) in the penal sum of $ , for which payment, well and truly to be made, we bind ourselves and our heirs, SURETY AMOUNT

executors, administrators, successors, and assigns, jointly and severally, firmly by these presents under the terms and conditions of Part 253 of Title 30 Code of Federal Regulations.

This bond is written to ensure the Principal complies with the requirements of section 1016(c) of the Act; and will inure to the benefit of claimants under Title I of the Act.

The condition of this obligation is that if the Principal will pay or cause to be paid to claimants any sum or sums for which the Principal may be held legally liable under Title I of the Act, then this obligation, to the extent of such payment, will be void, otherwise to remain in full force and effect.

4. The liability of the Surety will not be discharged by any payment or succession of payments hereunder, unless and until such payment or payments will amount in the aggregate to the penalty of the bond. In no event will the Surety’s obligation hereunder exceed the amount of the penalty, provided the Surety furnishes written notice to the Bureau of Ocean Energy Management, Regulation and Enforcement (BOEMRE) Oil Spill Financial Responsibility Program forthwith of all claims filed, judgments rendered, and payments made by the Surety under this bond.

Any claim for which the Principal may be liable under Title I of the Act may be brought directly against the Surety for claims asserted by the U.S. Government or, in the case of the Principal’s insolvency or petition for bankruptcy under Title 7 or 11, U.S.C. 101, for claims asserted by other claimants through the U.S. Coast Guard National Pollution Funds Center. In the event of a direct claim, the Surety will be entitled to invoke only (1) the rights and defenses permitted by Title I of the Act to the Principal, and (2) the defense that the incident giving rise to the claim was caused by the willful misconduct of the Principal.

5. This bond is effective the day of , , 12:01 a.m., central standard time

NUMBER MONTH YEAR

as stated herein and will continue in force until terminated as hereinafter provided. The Principal or the Surety may at any time terminate this bond by written notice sent by certified mail to the other party with a copy (plainly indicating the original notice was sent by certified mail) to the BOEMRE Oil Spill Financial Responsibility Program by certified mail. The termination becomes effective thirty (30) calendar days after actual receipt by the BOEMRE Oil Spill Financial Responsibility Program of written notice. The Surety will not be liable hereunder in connection with an incident occurring after the termination of this bond as herein provided; but termination will not affect the liability of the Surety in connection with an incident occurring before the termination becomes effective.

BOEMRE FORM MMS-1020 (Mo/Year– Supersedes all previous versions of form MMS-1020 which may not be used). Page 1 of 2

6. In witness whereof, the Principal and the Surety have executed this instrument on the day

of , , NUMBER

MONTH YEAR

PRINCIPAL:

________________________________________________________________

SIGNATURE (OF A COMPANY OFFICER WHO IS A CORPORATE PRINCIPAL)

________________________________________________________________

NAME (OF THE COMPANY OFFICER)

(CORPORATE SEAL)

________________________________________________________________

TITLE (OF THE COMPANY OFFICER)

SURETY:

________________________________________________________________

COMPANY NAME

________________________________________________________________

ADDRESS

________________________________________________________________

CITY STATE ZIP CODE

________________________________________________________________

SIGNATURE (OF CORPORATE SURETY)

________________________________________________________________

NAME (OF CORPORATE SURETY)

(CORPORATE SEAL)

________________________________________________________________

TITLE (OF CORPORATE SURETY)

BOEMRE FORM MMS-1020 (Mo/Year – Supersedes all previous versions of form MMS-1020 which may not be used). Page 2 of 2