0106 60-day renewal FR notice for form revision

2nd 60-day 0106 FR.pdf

30 CFR 553, Oil Spill Financial Responsibility for Offshore Facilities

0106 60-day renewal FR notice for form revision

OMB: 1010-0106

Document [pdf]
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Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

tkelley on DSK3SPTVN1PROD with NOTICES

including the Alabama, Tombigbee, and
Cahaba River systems. Recent
collections of the species have been
restricted to the lower Alabama River
below R.F. Henry Lock and Dam to the
confluence of the Tombigbee River, as
well as to the lower Cahaba River near
its confluence with the Alabama River;
however, incidents of such collections
are extremely rare. The last capture of
an Alabama sturgeon was on April 3,
2007, by biologists at the Alabama
Department of Conservation and Natural
Resources (ADCNR). The species was
last observed on April 23, 2009, by
ADCNR biologists. The Alabama
sturgeon is one of the rarest species of
fish in the nation and may be close to
extinction.
Restoring an endangered or
threatened animal or plant to the point
where it is again a secure, selfsustaining member of its ecosystem is a
primary goal of our endangered species
program. To help guide the recovery
effort, we prepare recovery plans for
most listed species. Recovery plans
describe actions considered necessary
for conservation of the species, establish
criteria for downlisting or delisting, and
estimate time and cost for implementing
recovery measures.
The Act requires the development of
recovery plans for listed species, unless
such a plan would not promote the
conservation of a particular species.
Section 4(f) of the Act requires us to
provide a public notice and an
opportunity for public review and
comment during recovery plan
development. The draft of this recovery
plan was available for public comment
from April 12 through June 11, 2012 (77
FR 21993). We considered the
information received via public
comments as well as from peer
reviewers in our preparation and
approval of this final recovery plan. We
also edited some sections of the draft
recovery plan to reflect these comments;
however, no substantial changes were
made to the draft plan.
Recovery Plan Components
The objective of this plan is to
provide a framework for the recovery of
the Alabama sturgeon so that protection
under the Act is no longer necessary.
Delisting of the species is not currently
foreseeable due to extreme curtailment
of range and extensive modification to
the riverine habitats. Therefore, this
recovery plan establishes criteria for
downlisting the Alabama sturgeon from
endangered to threatened.
Downlisting of the Alabama sturgeon
may be considered when the following
criteria are met: (1) A population
consisting of approximately 500

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sexually mature Alabama sturgeon is
shown to be surviving and naturally
reproducing in the Alabama/Cahaba
Rivers; (2) population studies show that
the Alabama sturgeon population is
naturally recruiting (consisting of
multiple age classes), sustainable over a
period of 20 years (2–3 generations), and
no longer requires hatchery
augmentation; and (3) an agreement is
in place that ensures adequate flows are
being delivered down the Alabama
River for successful development of
sturgeon larvae and passage of the fish
both upstream and downstream at dams
on the Alabama River.
Authority
The authority for this action is section
4(f) of the Endangered Species Act, 16
U.S.C. 1533 (f).
Dated: July 8, 2013.
Leopoldo Miranda,
Acting Regional Director, Southeast Region.
[FR Doc. 2013–18914 Filed 8–5–13; 8:45 am]
BILLING CODE 4310–55–P

DEPARTMENT OF THE INTERIOR
Bureau of Land Management
[LLMTC 00900.L16100000.DP0000]

Notice of Public Meeting, Eastern
Montana Resource Advisory Council

47723

individual during normal business
hours. The FIRS is available 24 hours a
day, 7 days a week to leave a message
or question with the above individual.
You will receive a reply during normal
business hours.
SUPPLEMENTARY INFORMATION: The 15member council advises the Secretary of
the Interior through the BLM on a
variety of planning and management
issues associated with public land
management in Montana. At these
meetings, topics will include: Eastern
Montana—Dakotas District, Miles City
and Billings Field Office manager
updates, Field Office Resource
Management Planning updates,
individual council member briefings
and other topics that the council may
raise. All meetings are open to the
public and the public may present
written comments to the council. Each
formal RAC meeting will also have time
allocated for hearing public comments.
Depending on the number of persons
wishing to comment and time available,
the time for individual oral comments
may be limited. Individuals who plan to
attend and need special assistance, such
as sign language interpretation, or other
reasonable accommodations should
contact the BLM as provided above.
Dated: July 24, 2013.
Diane M. Friez,
Eastern Montana—Dakotas District Manager.

Bureau of Land Management,
Interior.
ACTION: Notice of Public Meeting.

[FR Doc. 2013–18915 Filed 8–5–13; 8:45 am]

In accordance with the
Federal Land Policy and Management
Act (FLPMA) and the Federal Advisory
Committee Act of 1972 (FACA), the U.S.
Department of the Interior, Bureau of
Land Management (BLM) Eastern
Montana Resource Advisory Council
(RAC) will meet as indicated below.
DATES: The next regular meeting of the
Eastern Montana RAC will be held on
September 5, 2013 in Billings, Montana.
The meeting will start at 8:00 a.m. and
the public comment period will start at
11:00 a.m. and run for one hour. The
meeting will adjourn at around 3:30
p.m.
ADDRESSES: The meeting location will
be announced in a news release.
FOR FURTHER INFORMATION CONTACT:
Mark Jacobsen, Public Affairs Specialist,
BLM Eastern Montana/Dakotas District,
111 Garryowen Road, Miles City,
Montana, 59301, (406) 233–2831,
[email protected]. Persons who
use a telecommunications device for the
deaf (TDD) may call the Federal
Information Relay Service (FIRS) at 1–
800–677–8339 to contact the above

DEPARTMENT OF THE INTERIOR

AGENCY:

SUMMARY:

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BILLING CODE 4310–DN–P

Bureau of Ocean Energy Management
[OMB Control Number 1010–0106;
MMAA104000]

Information Collection: Forms for Oil
Spill Financial Responsibility for
Offshore Facilities; Proposed
Collection for OMB Review; Comment
Request
ACTION:

60-day notice.

To comply with the
Paperwork Reduction Act of 1995
(PRA), the Bureau of Ocean Energy
Management (BOEM) is inviting
comments on the proposed revision of
forms associated with a collection of
information that we will submit to the
Office of Management and Budget
(OMB) for review and approval. The
information collection request (ICR)
concerns the forms used for paperwork
requirements under 30 CFR 553, Oil
Spill Financial Responsibility for
Offshore Facilities.

SUMMARY:

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47724

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

Submit written comments by
October 7, 2013.
ADDRESSES: Please send your comments
on this ICR to the BOEM Information
Collection Clearance Officer, Arlene
Bajusz, Bureau of Ocean Energy
Management, 381 Elden Street, HM–
3127, Herndon, Virginia 20170 (mail); or
[email protected] (email); or
703–787–1209 (fax). Please reference
ICR 1010–0106 in your comment and
include your name and return address.
FOR FURTHER INFORMATION CONTACT:
Arlene Bajusz, Office of Policy,
Regulations, and Analysis at (703) 787–
1025. The revised forms are printed at
the end of this notice.
SUPPLEMENTARY INFORMATION: OMB
Control Number: 1010–0106.
Title: 30 CFR 553, Oil Spill Financial
Responsibility for Offshore Facilities.
Forms: BOEM–1016 through 1023 and
BOEM–1025.
Abstract: On May 1, 2013, BOEM
released a notice inviting public
comment on the information collection
renewal of requirements for BOEM’s Oil
Spill Financial Responsibility (OSFR)
regulations under 30 CFR 553 (78 FR
25472). The BOEM uses the information
collected under these regulations to
verify compliance with section 1016 of
the Oil Pollution Act of 1990, as
amended (OPA), and to confirm that
applicants can pay for cleanup and
damages resulting from oil spills and
other hydrocarbon discharges that
originate from Covered Offshore
Facilities (COFs). Since May, BOEM has
proposed revising the forms used with
this collection and is providing the 60day public comment period for the
revisions with this notice.
BOEM is splitting the function of
some forms and revising others to
clarify the responsibilities and financial
obligations of responsible parties and
applicants, as described in the Outer
Continental Shelf Lands Act, and to
better align the terminology and liability
with the provisions of OPA. These
revisions will better protect the Federal
Government from potential disputes and
litigation by clarifying that the primary
relationship is between the responsible
party and guarantor and that the
designated applicant/operator is
intended to function primarily in an
administrative capacity. The revisions
will also better align BOEM’s process
with that of the U.S. Coast Guard’s
National Pollution Fund Center, thereby
reducing the burden on industry in
complying with potentially conflicting
guidance on oil spill responsibility,
particularly with respect to offshore
facilities that also function as vessels.

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DATES:

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Below is a description of each affected
form, as well as any change in the
burden. The revised forms are also
printed at the end of this notice. Until
OMB approves these revisions, the
current forms remain in use and can be
located at http://www.boem.gov/AboutBOEM/Procurement-BusinessOpportunities/BOEM-OCS-OperationForms/BOEM-OCS-OperationForms.aspx.
Form BOEM–1016, Designated
Applicant Information Certification.
This form remains essentially the same
except for updating the choices of forms
and clarifying the administrative role of
the designated applicant. No change in
the 1-hour burden is expected.
Form BOEM–1017, Appointment of
Designated Applicant. This form
remains essentially the same except for
changing the title, clarifying the
administrative role of the designated
applicant, and adding a column to
record depth ranges, when applicable.
No change in the 9-hour burden is
expected.
Form BOEM–1018, Self-Insurance
Information. The original form posed
potential confusion because it served
two purposes, both to provide evidence
of self-insurance (for responsible
parties) and as an indemnity (executed
by persons other than the responsible
party). Thus, the form has been split
into two forms (BOEM–1018 and
BOEM–1023). BOEM–1018 focuses on
self-insurance only and is reworded to
more closely align with the
requirements of OPA, adding an
agreement to update/renew expiring or
terminated instruments and a signature
section. No change in the 1-hour burden
is expected.
Form BOEM–1019, Insurance
Certificate. The language and
agreements in this form have been
reworded for compliance with OPA, to
clarify that the insurer is responsible for
OPA liabilities of the responsible
parties, and to add an agreement to
update/renew expiring or terminated
instruments. No change in the 120-hour
burden is expected.
Form BOEM–1020, Surety Bond. The
language and agreements in this form
have been reworded for compliance
with OPA, to clarify that the Surety is
responsible for OPA liabilities of the
responsible parties, and to add an
agreement to update/renew expiring or
terminated instruments. No change in
the 24-hour burden is expected.
Forms BOEM–1021, Covered Offshore
Facilities, and BOEM–1022, Covered
Offshore Facility Changes. These forms
remain essentially the same except for
rewording of the subtitles to match the
other forms and adding a provision for

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rights-of-way. There is no change in the
1-hour burden for BOEM–1022;
however, based on respondent input we
are increasing the burden for BOEM–
1021 from 3 to 6 hours.
Form BOEM–1023, Financial
Guarantee. This new form replaces the
indemnity agreement (previously part of
BOEM–1018) with a provision that an
affiliated firm, such as a corporate
parent, may promise to satisfy any
claims against the responsible parties. It
also adds an agreement to update/renew
expiring or terminated instruments and
a signature section. The hour burden is
estimated as 1.5 hours.
Form BOEM–1025, Independent
Designated Applicant Information
Certification. This new form allows a
designated applicant, who is not also a
responsible party, to continue to agree
to be jointly and severally liable under
OPA until BOEM promulgates
regulations that will repeal this
requirement. We estimate the burden
hour to be 1 hour.
We will protect information from
respondents considered proprietary
under the Freedom of Information Act
(5 U.S.C. 552) and its implementing
regulations (43 CFR part 2) and under
regulations at 30 CFR 550.197, ‘‘Data
and information to be made available to
the public or for limited inspection.’’ No
items of a sensitive nature are being
collected. Responses are mandatory.
Frequency: On occasion or annual
basis.
Description of Respondents: Holders
of leases, permits, and rights of use and
easement in the Outer Continental Shelf
and in State coastal waters and those
who will appoint designated applicants
to process their OSFR paperwork. Other
respondents will be the designated
applicants’ insurance agents and
brokers, bonding companies, and
guarantors.
Public Disclosure Statement: The PRA
(44 U.S.C. 3501, et seq.) provides that an
agency may not conduct or sponsor a
collection of information unless it
displays a currently valid OMB control
number. Until OMB approves a
collection of information, you are not
obligated to respond.
Comments: Before submitting an ICR
to OMB, PRA section 3506(c)(2)(A)
requires each agency ‘‘. . . to provide
notice . . . and otherwise consult with
members of the public and affected
agencies concerning each proposed
collection of information . . .’’.
Agencies must specifically solicit
comments to: (a) Evaluate whether the
proposed collection of information is
necessary for the agency to perform its
duties, including whether the
information is useful; (b) evaluate the

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Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

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accuracy of the agency’s estimate of the
burden of the proposed collection of
information; (c) enhance the quality,
usefulness, and clarity of the
information to be collected; and (d)
minimize the burden on the
respondents, including the use of
automated collection techniques or
other forms of information technology.
Agencies must also estimate the nonhour cost burdens to respondents or
recordkeepers resulting from the
collection of information. Therefore, if
you have costs to generate, maintain,
and disclose this information, you
should comment and provide your total
capital and startup cost components or
annual operation, maintenance, and
purchase of service components. You
should describe the methods you use to
estimate major cost factors, including

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system and technology acquisition,
expected useful life of capital
equipment, discount rate(s), and the
period over which you incur costs.
Capital and startup costs include,
among other items, computers and
software you purchase to prepare for
collecting information, monitoring, and
record storage facilities. You should not
include estimates for equipment or
services purchased: (i) Before October 1,
1995; (ii) to comply with requirements
not associated with the information
collection; (iii) for reasons other than to
provide information or keep records for
the Government; or (iv) as part of
customary and usual business or private
practices.
We will summarize written responses
to this notice and address them in our
submission for OMB approval. As a

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47725

result of your comments, we will make
any necessary adjustments to the burden
estimates in our submission to OMB.
Public Availability of Comments:
Before including your address, phone
number, email address, or other
personal identifying information in your
comment, you should be aware that
your entire comment—including your
personal identifying information—may
be made publicly available at any time.
While you can ask us in your comment
to withhold your personal identifying
information from public review, we
cannot guarantee that we will be able to
do so.
Dated: July 31, 2013.
Deanna Meyer-Pietruszka,
Chief, Office of Policy, Regulations, and
Analysis.
BILLING CODE 4310–MR–P

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47726

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: XXX)()(X)()(
Expiration Date: xxxxxxxxx

PAPERWORK REDUCTION ACT STATEMENT
BUREAU OF OCEAN ENERGY MANAGEMENT
OIL POLLUTION ACT OF 1990
OIL SPILL FINANCIAL RESPONSIBILITY FOR OFFSHORE FACILITIES
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) requires us to inform you that the Bureau of
Ocean Energy Management (BOEM) collects this information to:
1.

Provide a standard method for establishing eligibility for oil spill financial responsibility (OSFR) for
offshore facilities;

2.

Identify and maintain a record of those offshore facilities that have a potential oil spill liability;

3.

Establish and maintain a continuous record, over the liability term specified in Title I of the Oil
Pollution Act of 1990, of financial evidence and instruments established to pay claims for oil spill
cleanup and damages resulting from operations conducted on offshore facilities and the
transportation of oil from offshore platforms and wells;

4.

Establish and maintain a continuous record of Responsible Parties, as defined in Title I of the Oil
Pollution Act of 1990, and their agents or Authorized Representatives for oil spill financial
responsibility for offshore facilities; and

5.

Establish and maintain a continuous record, over the liability term specified in Title I of the Oil
Pollution Act of 1990, of persons to contact and U.S. Agents for Service of Process for claims
associated with oil spills from offshore facilities.

The BOEM will routinely use the information to:
1.

Ensure compliance of offshore lessees and ovvners and operators of offshore facilities with Title I of
the Oil Pollution Act of 1990;

2

Establish eligibility of applicants for OSFR; and

3.

Establish a reference source of names, addresses, and telephone numbers of Responsible Parties
for offshore facilities and their Authorized Representatives and Guarantors for claims associated
with oil pollution from designated offshore facilities.

Responses are mandatory (33 U.S.C. 2716). No confidential or proprietary information is required to be
submitted. The BOEM considers oil spill financial responsibility demonstrations, including supporting audited
financial statements, to be public information open for review under the Freedom of Information Act (5
U.8.C. 552).
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 valid Office of Management and Budget (OMB) Control Number.
The public reporting burden for an application for certification of oil spill financial responsibility is listed
below. The burden includes the time for reViewing instructions, gathering and maintaining data, and
completing and reviewing the application. The average burden for each of the forms and required
information that could comprise a submission is:
DeSignated Applicant Information Certification ....................... 1 hour
AppOintment of DeSignated Applicant ............ ., ............ ., ..... 9 hours
Self-Insurance Information ...................................................1 hour
Insurance Certificate ........................................................ 120 hours
Surety Bond ...................................................................... 24 hours
Covered Offshore Facilities ................................................... 6 hours
Covered Offshore Facility Changes ........................................ 1 hour
Financial Guarantee
............................. 1.5 hours
Independent Designated Applicant Information Certification .. 1 hour

Comments regarding the burden estimate or any other aspect of this form should be directed to the
Information Collection Clearance Officer, Bureau of Ocean Energy Management, 381 Elden Street,
Herndon, VA 20170.

(Month/year)

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Form BOEM-1016,
Form BOEM-1017,
Form BOEM-1 018,
Form BOEM-1019,
Form BOEM-1020,
Form BOEM-1 021,
Form BOEM-1022,
Form BOEM-1023,
Form BOEM-1025,

47727

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

DESIGNATED APPLICANT INFORMATION CERTIFICATION
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _---:==~=~=------BOEM COMPANY NUMBER

COMPANY LEGAL NAME

ADDRESS

BOEM COMPANY REGION

CITY

STATE

ZIP CODE
(

)

CONTACT PERSON

AREA CODE and TELEPHONE NUMBER

CONTACT PERSON'S TITLE

AREA CODE and FAX NUMBER

(

)

E-MAIL ADDRESS

• Self-Insurance (BOEM-1018)

$
--------~---------

• Financial Guarantee (BOEM~1023)$

~--------------~

• Surety Bonds (BOEM-1020)
• Insurance (BOEM-1019)
• Other

TOTAL AMOUNT

------------------$
------------------$
-----------------$
------------------$

3. The Designated Applicant, for all of the Responsible Parties whose Designated Applicant authorizations (form BOEM-1 017)
are on file or attached, agrees to establish and maintain oil spill financial responsibility (OSFR), under the Oil Pollution Act of
1990, as amended, 33 U.S.C. § 2701 et seq., for all said Responsible Parties. This OSFR will be maintained continuously
for those leases, permits, rights of use and easement, and pipeline segments identified in form(s) BOEM-1 017 on file or
attached. I will immediately notify the Responsible Parties of any claims that I receive. I will immediately notify the BOEM
OSFR program if information on this form changes. I certify the information contained herein, including all the information on
the attached forms, is complete, true, and correct to the best of my information and knowledge.

NAME OF AUTHORIZED REPRESENTATIVE

SIGNATURE

TITLE OF AUTHORIZED REPRESENTATIVE

DATE

4. The Designated Applicant's U.S. Agent for Service of Process is:
NAME
BOEM COMPANY NUMBER

ADDRESS

CITY
)

AREA CODE and TELEPHONE NUMBER

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STATE
(

ZIP CODE

)

AREA CODE and FAX NUMBER

E-MAIL ADDRESS

FORM BOEM-1016 (Monthlyear)
Previous Editions are Obsolete.

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(

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Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

APPOINTMENT OF DESIGNATED APPLICANT
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _ _-:::-::==-:-=:=-:-:-":':":"':=-_ _ _ _ _ __
COMPANY LEGAL NAME

BOEM COMPANY NUMBER

ADDRESS

BOEM COMPANY REGION

CITY

STATE

ZIP CODE

2. Responsible Party: _ _ _ _ _ _ _ _ _ _ _-:-:..,..,."..,..,.,.,.,,.,..,,,.,,.,.,....,.,...,.,,.,,,,.._ _ __
COMPANY LEGAL NAME

BOEM COMPANY NUMBER

ADDRESS

BOEM COMPANY REGION

CITY

STATE

CONTACT PERSON
(

ZIP CODE

CONTACT PERSON'S TITLE

)

(

AREA CODE and TELEPHONE NUMBER

)

AREA CODE and FAX NUMBER

E·MAIL ADDRESS

3. I, the undersigned, serving as the Authorized Representative of the Responsible Party named in section 2, do hereby
appoint and authorize the Designated Applicant identified in section 1 to act on behalf of the Responsible party to obtain a
certification of oil spill financial responsibility (OSFR) for each covered offshore facility at the locations described in section
5, and to establish and maintain OSFR on the Responsible Party's behalf for these specified covered offshore facilities in
accordance with 30 CFR Part 553 and in the amounts specified by the Bureau of Ocean Energy Management (BOEM). On
behalf of the Responsible Party, I explicitly agree that the Responsible Party be strictly liable, jointly and severally, together
with the other Responsible Parties for each covered offshore facility described in section 5, for all oil spill removal costs and
damages in accordance with the Oil Pollution Act of 1990, as amended, 33 U.S.C. § 2701 et seq.

==-______.

This appointment is effective beginning on _ _ _ _ _ _ _ _ _ _

I agree, on behalf of the

DATE

Responsible Party, that the Responsible Party will notify the BOEM oil spill financial responsibility program in writing when
this appointment is canceled; that the Responsible Party will concurrently appoint a substitute Designated Applicant; and
that the Responsible Party shall be bound by the actions of the Designated Applicant hereby appointed until such time as
BOEM receives such notice and a substitute DeSignated Applicant so appointed.

NAME OF AUTHORIZED REPRESENTATIVE

SIGNATURE

TITLE OF AUTHORIZED REPRESENTATIVE

DATE

4. The Responsible Party's U.S. Agent for Service of Process is:
NAME
BOEM COMPANY NUMBER

ADDRESS

STATE

CITY
)

(

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)

AREA CODE and FAX NUMBER

E·MAIL ADDRESS

FORM BOEM-1017 (MonthNear)
Previous Editions are Obsolete.

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AREA CODE and TELEPHONE NUMBER

ZIP CODE

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Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
5. Locations of Covered Offshore Facilities:

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..••..

'i . .
LEASE

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(lfA'pl>lj.cabl~)<

PAGE20F 2

FORM BOEM·1017 (Month/year)
Previous Editions are Obsolete.

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STAte
I;)R
QCS

47730

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxxxx

SELF·INSURANCE INFORMATION
RESPONSIBLE PARTY SELF-INSURANCE CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. I, the undersigned, as the Authorized Representative of the Responsible Party (described in section 6), certifies that
the Responsible Party is acting in the capacity of a Self-Insurer, in accordance with the requirements of 30 CFR
553.41.

2. The amount of coverage for which evidence of oil spill financial responsibility is being established by the
Responsible Party using self-insurance is:

I

FROM

~
[:OWERLlMI_T[ ITO

$

[$

UPPER LIMIT (MUST BE
COMPLETED)

3. This coverage is effective: _ _-"..,.."..",.._ _ _ _ and expires on the first calendar day of the fifth month
DATE

after the close of the Self-Insurer's fiscal year, which ends: _ _ _ _ _ _ _ _ __
DATE

4. The Responsible Party providing evidence of oil spill financial responsibility in the form of Self-Insurance is:

COMPANY LEGAL NAME

BOEM COMPANY NUMBER

ADDRESS

CITY

STATE

ZIP CODE

CONTACT PERSON FOR CLAIMS

CONTACT PERSON'S TITLE

AREA CODE AND TELEPHONE NUMBER

AREA CODE AND FAX NUMBER

E-MAIL ADDRESS

5. The undersigned certifies on behalf of the Responsible Party that the requirements set forth in 30 CFR Part 553 and
specifically §§ 553.21 through 553.28 have been met.

FORM BOEM-1018 (MonthNear)
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The undersigned further agrees that the Responsible Party, pursuant to the requirements of 30 CFR 553.15, will notify
the BOEM oil spill financial responsibility program in the event the Responsible Party is no longer able to maintain
evidence of oil spill financial responsibility as a Self-Insurer in the amounts stated in section 2 above.

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

47731

6. The Responsible Party, as Self-Insurer, acting through the Designated Applicant must, no later than the first calendar
day of the fifth month after the close of your fiscal year, submit either a renewal of this Self-Insurance or other
acceptable evidence of financial responsibility.

NAME OF AUTHORIZED REPRESENTATIvE OF
RESPONSIBLE PARTY

SIGNATURE

TITLE OF AUTHORIZED REPRESENTATIVE OF
RESPONSIBLE PARTY

DATE

7. The Self-Insurer's U.S. Agent for Service of Process is:

NAME

BOEM COMPANY NUMBER

ADDRESS

AREA CODE AND TELEPHONE NUMBER

AREA CODE AND FAX NUMBER

E-MAIL ADDRESS

8. In witness whereof, the Designated Applicant and the Self-Insurer have executed this instrument on the _ _ _ __
dayof _ _ _ _ _ _ _ _ _ _ .
MONTH

YEAR

Designated Applicant for the Responsible Parties named herein:

SIGNATURE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

NAME OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

TITLE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

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FORM BOEM-1018 (MonthlYear)
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47732

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

INSURANCE CERTIFICATE
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _ _-:-:=~,..,..".,,,..,.,...,.,..,.,_::_=_------COMPANY LEGAL NAME

_________
BOEM COMPANY NUMBER

2. The amount of insurance coverage established by the named Insurers as evidence of oil spill financial
responsibility (OSFR) for the Responsible Parties, identified in form(s) BOEM-1017 on file or attached,
(hereafter the Insured), as represented by the Designated Applicant, in compliance with the Oil Pollution Act of
1990, as amended, 33 U.S.C. §§ 2701-2672 (hereafter the Act) and with Title 30 Code of Federal Regulations
(CFR), part 553, for anyone incident is:
FROM $.--:::==~=~=~;-­

TO:$--~U~P~P~ER~L~IM~IT~O~F~---­

STARTING AMOUNT ABOVE ANY
DEDUCTIBLE OR EXCESS AMOUNT

THIS INSURANCE LAYER

The following insurance option has been selected to provide this coverage:

o Full Option-Insurance is provided for the first full $
million without deductible.
o Deductible Option-Insurance is provided for the amount of $~_ _ million less the deductible amount
of$ ____ .

D Excess Option-Insurance is provided for the amount of $_ _ _ million in excess of the amount of
of $ _ _ _ _ million.

3. This coverage is effective: _ _ _--:=:--_ _ at
DATE

and expires: _ _ _::-::-:::=-_ _
Central Standard Time

DATE

at _____~~~~~----------Centra! Standard Time
4. The Insurer may at any time cancel this insurance certificate by written notice of intent to cancel sent by certified
mail to the Designated Applicant with copies (plainly indicating the original notice was sent by certified mail) to all
Responsible Parties and to the BOEM oil spill financial responsibility program by certified mail. This instrument will
remain in force and the undersigned will remain liable until the expiration date or until the earlier of (1) thirty
calendar days after BOEM and the Designated Applicant receive a notification of your intent to cancel this
insurance certificate; (2) BOEM receives other acceptable OSFR evidence from the Designated Applicant; or (3) all
the COFs to which this Insurance Certificate applies have been permanently abandoned either in compliance with
30 CFR part 250 or the equivalent state requirements. The undersigned agrees that any termination of this
Insurance Certificate will not affect the liability of the Insurer for any claims that arise from an incident (i.e., oil
discharge or substantial threat of the discharge of oil) that occurs on or before the effective date of termination of
this Insurance Certificate.

S. The named Insurers agree that any suit or claim for which the Responsible Parties identified in form(s) BOEM-1017,
on file or attached, represented by the aforementioned Designated Applicant may be liable under Title I of the Act
may be brought directly against the named Insurers for claims up to the amount of insurance coverage asserted by
the U.S. government or by other claimants when a Responsible Party denies or fails to pay a claim on the basis of
insolvency or a Responsible Party has petitioned fOf bankruptcy under Title 11 of the U.S. Code.

PAGE 1 OFS

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6. The undersigned further agrees not to use any defense except those that would be available to a Responsible Party
for whom the insurance was provided or that the incident leading to the claim for removal costs or damages was
caused by willful misconduct of a Responsible Party covered by this insurance.

47733

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

7. The undersigned Responsible Party further agrees, pursuant to the requirements of 30 CFR 553.15, to notify the
BOEM oil spill financial responsibility program in the event the Responsible Party is no longer able to maintain
evidence of oil spill financial responsibility to the extent stated in section 2 above.
8. The Designated Applicant must, no later than the first calendar day of the fifth month after the close of the Insurer's
fiscal year or expiration if earlier, submit either a renewal of this insurance or other acceptable evidence of financial
responsibility.

9. Insurance agent or broker for this Insurance Certificate:
COMPANY NAME

BOEM COMPANY NUMBER

ADDRESS

CITY
(

STATE

)

(

AREA CODE and TELEPHONE NUMBER

COUNTRY (Ifnot U.S.A.)

ZIP CODE

)

E-MAIL ADDRESS

AREA CODE and FAX NUMBER

10. As an Authorized Representative of the insurance agent or broker identified above, I certify that the information
contained in this Insurance Certificate is accurate and correct, that quota shares total 100 percent for this
Insurance Certificate, and that this Insurance Certificate and the named Insurers, complies with the requirements
stated in 30 CFR 553.29. The identified insurance agent or broker agrees to maintain and provide to the
Designated Applicant and BOEM, on demand, any delegations of authority to a broker or an underwriter of another
insurer or underwriting manager to bind a named Insurer to all risks and liabilities specified in Title I of the Act.

NAME

SIGNATURE

DATE

11.The named Insurers, listed below, certify that the Insured is insured by the named Insurers for the offshore facilities,
as specified below, against liability for removal costs and damages to which the Insured could be subjected under
Title I of the Oil Pollution Act and 30 CFR 553 within the insurance layer specified.
The following offshore facility coverage option has been selected:

D

General Option-All covered offshore facilities for which the named DeSignated Applicant serves in that
capacity.

D

Schedule Option- All covered offshore facilities on the Designated Applicant's attached
information form and schedule of properties forms, effective

PAGE 2 OF 5

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DATE

47734

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

12. The named Insurers designate the following U,S, Agent for Service of Process for this Insurance
Certificate:
NAME

BOEM COMPANY NUMBER

ADDRESS

STATE

CITY
(

ZIP CODE

)

AREA CODE and TELEPHONE NUMBER

E-MAIL ADDRESS

13. In witness whereof, the Designated Applicant for the Responsible Parties and the named Insurers have
executed this instrument on the ______ day of _ _ _ _ _ _ _ _ '
MONTH

YEAR

Designated Applicant for the Responsible Parties named herein:

SIGNATURE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

NAME OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

TITLE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

Named Insurers:

COMPANY NAME

ADDRESS

STATE

ZIP CODE

PAGE 3 OF 5

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CITY

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

47735

EN06AU13.032

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PAGE40F5

47736

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of the Interior
Bureau of Ocean Energy Management

OBM Control No.: xxxxxxx
Expiration Date: xxxxxxxxx

SURETY BOND
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _ _.."..".=~":'"'=',...,..,..~=_-------_:::_:;;::::;:_;_=::_=_;_::_;:_;_:;_::_=
COMPANY LEGAL NAME

BOEM COMPANY NUMBER

2. Surety Company Bond Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____
3. The Designated Applicant and Responsible Parties, identified in formes) BOEM-1 017 on file or attached, and
_----:.,.-:-:-:==-===:-:~=_:_:_::_:_--, a company created under the laws of
NAME OF SURETY COMPANY

, and
STATE

authorized to do business in the United States, as Surety (hereinafter called Surety), are held and firmly bound
unto the United States of America and other claimants for damages and removal cost liability under the Oil
, for
Pollution Act of 1990, 33 U.S. C. § 2701 et seq. (hereinafter called Act), in the sum of $
AMOUNT

which payment, we bind ourselves and our heirs, executors, administrators, successors, and assigns, jOintly and
severally, under the terms and conditions of Part 553 of Title 30 of the Code of Federal Regulations. This bond is
hereby provided on behalf of the Responsible Parties to comply with the requirements of 33 U.S. C. § 2716(c) and
is offered to satisfy any claim made under OPA.

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 timely written
notice to the Bureau of Ocean Energy Management (BOEM) oil spill financial responsibility (OSRP) program of
all claims filed, judgments rendered, and payments made by the Surety under this bond.

5. This bond is effective the ___ day of -:-:-::=.,----'
NUMBER

MONTH

----::-;:-.:-::,--'
YEAR

12:01 a.m., Eastern Standard Time

as stated herein and will continue in force until terminated as hereinafter provided. The Surety may at any time
terminate this bond by written notice of intent to cancel sent by certified mail to the Designated Applicant with
copies (plainly indicating the original notice was sent by certified mail) to all Responsible Parties and to the BOEM
oil spill financial responsibility program by certified mail. This surety bond will remain in force and the undersigned
will remain liable until termination on the earlier of: (1) thirty calendar days after BOEM and the Designated
Applicant receive a notification of an intent to cancel this Surety Bond; (2) BOEM receives other acceptable OSFR
evidence from the Designated Applicant; or (3) all the COFs to which this Surety Bond applies have been
permanently abandoned either in compliance with 30 CFR part 250 or equivalent state requirements. The Surety
will not be liable 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.
6. The undersigned agree that any suit or claim for which the Responsible Parties identified in formes) BOEM-1 017,
on file or attached, represented by the aforementioned Designated Applicant may be liable under Title I of the Act
may be brought directly against the Surety for claims up to the amount of the penalty asserted by the U.S.
government or by other claimants when a Responsible Party denies or fails to pay a claim on the basis of
insolvency or a Responsible Party has petitioned for bankruptcy under Title 11 of the U.S. Code.

PAGE 1 OF2

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7. The undersigned further agrees not to use any defense except those that would be available to a Responsible
Party for whom the Surety was provided or that the incident leading to the claim for removal costs or damages
was caused by willful misconduct of a Responsible Party covered by this Surety Bond.

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

47737

8. The undersigned further agrees that the Responsible Party, pursuant to the requirements of 30 CFR 553.15, will
notify the BOEM oil spill financial responsibility program in the event the Responsible Party is no longer able to
maintain evidence of oil spill financial responsibility to the extent stated in section 3 above.
g. The Designated Applicant must, no later than the first calendar day of the fifth month after the close of your
Financial Guarantor's fiscal year or termination if earlier, submit either a renewal of this Surety Bond or other
acceptable evidence of financial responsibility.
10. In witness whereof, the Designated Applicant and the Surety have executed this instrument on the _ _ _ __
dayof ____________
MONTH

YEAR

Designated Applicant:

SIGNATURE OF AUTHORIZED REPRESENTATIVE

------------------------NAME OF AUTHORIZED REPRESENTATIVE

TITLE OF AUTHORIZED REPRESENTATIVE

Surety:

COMPANY NAME

ADDRESS

--------------------------CITY
STATE
ZIP CODE

NAME OF AUTHORIZED REPRESENTATIVE

PAGE20F2

FORM BOEM-1020 (Month/year)
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TITLE OF AUTHORIZED REPRESENTATIVE

47738

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

COVERED OFFSHORE FACILITIES
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _ _~==~~~_==_------COMPANY LEGAL NAME

BOEM COMPANY NUMBER

2. The following list comprises all of the _ _ _---:'7~:-=::-_ _ _ locations of covered offshore facilities to be covered
NUMBER

by my certification of oil spill financial responsibility.

NAME OF AUTHORIZED REPRESENTATIVE

SIGNATURE OF AUTHORIZED REPRESENTATIVE

TITLE

DATE

FORM BOEM-1021 (MonthlYear)

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3. Locations of covered offshore facilities:

47739

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
3. Locations of covered offshore facilities (continued):

STATE
OR
OCSREGION

LEASE
NUMBER

ALIQUOT
PORTION
(If Applicable)

AREA
NAME

BLOCK
NUMBER

PERMIT
NUMBER

RUEor
ROW
NUMBER

PIPELINE
SEGMENT
NUMBER

POTENTIAL
WORST
CASE OIL·
SPILL
DISCHARGE
(In Barrels)

PAGE20F 2

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If additional space is required, additional copies of this page may be attached as continuation pages.

47740

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

U.S. Department of Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

COVERED OFFSHORE FACILITY CHANGES
CERTIFICA TION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _ _-:-:-~~~~~=_------COMPANY LEGAL NAME

BOEM COMPANY NUMBER

2. The following list comprises all of _________........- - - changes to locations of covered offshore facilities
NUMBER

or potential worst case oil spill discharges listed in the previously submitted certification of oil spill financial responsibility
of _ _ _ _ _ _ __
DATE
SIGNATURE OF AUTHORIZED REPRESENTATNE

NAME OF AUTHORIZED REPRESENTATIVE

TITLE

DATE

3. Changes to locations of covered offshore facilities or potential worst case oil-spill discharges:

StATE
I<:;>R
I

oeg

REGION

.....

i

l.EASE
NUMBER
.'.

.......

AI.IQUQT
PORTION

(If Applicablet)

....

AREA
NAME

..•.
IilLOCK

PERMI,.
NUMBER

.·. NuN1SI:~
.

.•.•

. '.

I····

\I

.'. .•

. '.,

RUE OR '.'
ROW.'

I ...NUMBER
. .'

' . ....

POTENTIAl;,

~IPEl.IN~ .'
W2010

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If additional space is required, additional copies of this page may be attached as continuation pages.

47741

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxx

FINANCIAl..; GUARANTEE
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

1. Designated Applicant: _ _ _ _ _ _ _ _ _-:-:'-:-:-:-:-:--:---:-~_:_::_-------- --=--::-::::-c:-:c--:-:c:-~=_::_::_=_==_COMPANY LEGAL NAME

BOEM COMPANY NUMBER

2. The Responsible Parties, identified in form(s) BOEM-1017 on file or attached, and _ _--:-:-::-:=-=-==-:-_ _ ,
ENTITY

a

created under the laws of
TYPE OF ENTITY

STATE

and authorized to do business in the United States, as Guarantor, (hereinafter called Guarantor), agree to be jOintly
and severally liable to the United States of America and other claimants for damages and removal costs under the
Oil Pollution Act of 1990, as amended, 33 U.S. C. § 2701 et seq. (hereinafter called OPA), in the sum indicated in
section 4, for which payment our heirs, executors, administrators, successors, and assigns will also be liable, under
the terms and conditions of Title 30 part 553 of the Code of Federal Regulations (CFR).
This Guarantee is hereby provided on behalf of the Responsible Parties to comply with the requirements of 33
U.S.C. 2716(c) and is offered to satisfy any claim made under OPA.

3. For the purpose of this application, the undersigned is acting in the capacity of a Financial Guarantor in
accordance with the requirements of 30 CFR 553.32.
4. The amount of coverage for which evidence of oil spill financial responsibility (OSFR) is being established
is:

5. This coverage is effective: _ _ _ _ _ _ _ and expires on the first calendar day of the fifth month after the
DATE

close of the Financial Guarantor's fiscal year, which ends: _ _ _ _ __

6. The Financial Guarantor may at any time give notice of intent to cancel this Guarantee by written notice

FORM BOEM·1023 (MonthNear)
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sent by certified mail to the Designated Applicant with copies (plainly indicating the original notice was sent
by certified mail) to all Responsible Parties and to the BOEM oil spill financial responsibility program by
certified mail. This instrument will remain in force and the undersigned will remain liable until the expiration
date above or until the earlier of: (1) thirty calendar days after Bureau of Ocean Energy Management
(BOEM) and the Designated Applicant receive from the instrument issuer a notification of intent to cancel;
(2) BOEM receives other acceptable OSFR evidence from your Designated Applicant; or (3) all the COFs
to which the instrument applies are permanently abandoned in compliance with 30 CFR Part 250 or
equivalent state requirements. The undersigned agrees that termination of this instrument will
not affect the liability of the Financial Guarantor for claims arising from an incident (I.e., oil discharge or
substantial threat of the discharge of oil) that occurs on or before the effective date of termination of this
Guarantee.

47742

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
The undersigned agrees that any suit or claim for which any Responsible Parties identified in formes)
BOEM-1017, on file or attached, represented by the aforementioned Designated Applicant may be liable
under Title I of the Act may be brought directly against the Financial Guarantor for claims up to the amount
of the penalty asserted by the U.S. government or other claimants when a Responsible Party denies or
fails to pay a claim on the basis of insolvency or a Responsible Party has petitioned for bankruptcy under
Title 11 ofthe U.S. Code.
The undersigned further agrees not to use any defenses except those that would be available to a Responsible
Party for whom the Guarantee was provided or that the incident (Le., oil discharge or a substantial threat of the
discharge of oil) leading to the claim for removal costs or damages was caused by willful misconduct of a
Responsible Party for whom the Designated Applicant demonstrated OSFR.

7. Financial Guarantor providing evidence of oil spill financial responsibility in the form of a Guarantee.
COMPANY LEGAL NAME

BOEM COMPANY NUMBER

ADDRESS

CITY

STATE

ZIP CODE

CONTACT PERSON FOR CLAIMS

CONTACT PERSON'S TITLE

AREA CODE AND FAX NUMBER

AREA CODE AND TELEPHONE NUMBER

E-MAIL ADDRESS

8. The undersigned, as an Authorized Representative of the above-named Financial Guarantor, certifies on
behalf of the Financial Guarantor that the requirements set forth in 30 CFR Part 553, and specifically
§§ 553.20,553.23-28, 553.30 and 553.40 have been met, and further agrees that, the Financial Guarantor,
pursuant to the requirements of 30 CFR 553.15, will notify the BOEM oil spill financial responsibility program
in the event that the Financial Guarantor is no longer able to maintain evidence of oil spill financial
responsibility to the extent stated in section 4 above.
NAME

SIGNATURE

TITLE

DATE

9. The Financial Guarantor's U.S. Agent for Service of Process is:
BOEM COMPANY NUMBER

NAME

ADDRESS

CITY

AREA CODE AND FAX NUMBER

AREA CODE AND TELEPHONE NUMBER

E-MAIL ADDRESS

FORM BOEM-1023 (MonthNear)
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ZIP CODE

STATE

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

47743

10. The liability of the Financial Guarantor will not be discharged by any payment or succession of payments made,
unless and until such payment or payments will amount in the aggregate to the amount of the Guarantee. In no
event will the Financial Guarantor's obligation exceed the amount of the Guarantee, provided the Financial
Guarantor furnishes timely written notice to the BOEM oil spill financial responsibility program of all claims filed,
judgments rendered, and payments made by the Financial Guarantor under this Guarantee.

11. The Designated Applicant must, no later than the first calendar day of the fifth month after the close of your
Financial Guarantor's fiscal year or expiration if earlier, submit either a renewal of this Financial Guarantee or
other acceptable evidence of financial responsibility.

12. In witness whereof, the Designated Applicant for the Responsible Parties and the Financial Guarantor have
executed this instrument on the
day of _ _ _ _ _ _ __
MONTH

YEAR

Designated Applicant for the Responsible Parties named herein:

SIGNATURE OF AUTHORIZED REPRESENTATIVE

NAME OF AUTHORIZED REPRESENTATIVE

TITLE OF AUTHORIZED REPRESENTATIVE

Financial Guarantor:

SIGNATURE

NAME

FORM BOEM-1023 (MonthlYear)
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TITLE

47744

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

RESPONSIBLE PARTIES COVERED BY THIS AGREEMENT

PAGE40F4

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Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices
U.S. Department of the Interior
Bureau of Ocean Energy Management

47745

OMB Control No.: xxxxxxx
Expiration Date: xxxxxxxx

INDEPENDENT DESIGNATED APPLICANT INFORMATION CERTIFICATION
CERTIFICATION OF OIL SPILL FINANCIAL RESPONSIBILITY
IN ACCORDANCE WITH THE REQUIREMENTS OF THE OIL POLLUTION ACT OF 1990
(TYPE OR PRINT ALL INFORMATION EXCEPT SIGNATURES)

This form is intended for use by Designated Applicants that are not also Responsible Parties,
as defined in BOEM Regulations at 30 CFR part 553.

1.

Designated Applicant:
COMPANY LEGAL NAME

BOEM COMPANY NUMBER

ADDRESS

BOEM COMPANY REGION

CITY

STATE

ZIP CODE

(--)----------CONTACT PERSON

AREA CODE AND TELEPHONE NUMBER

CONTACT PERSON'S TITLE

AREA CODE AND FAX NUMBER

E-MAIL ADDRESS

2. Summary of Evidence of Oil Spill Financial Responsibility:
As an Authorized Representative of the Designated Applicant, I explicitly agree that the Designated
Applicant will be jointly and severally liable for claims, under the Oil Pollution Act of 1990, as amended,
33 U.S.C. § 2701 et seq., with the Responsible Parties for the covered offshore facilities covered by this
certification.

NAME OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

SIGNATURE

DATE

FORM BOEM-1025 (Month/year)
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TITLE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT

47746

Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices

[FR Doc. 2013–18923 Filed 8–5–13; 8:45 am]
BILLING CODE 4310–MR–C

DEPARTMENT OF THE INTERIOR
Bureau of Ocean Energy Management
[MMAA104000]

Environmental Documents Prepared
for Oil, Gas, and Mineral Operations by
the Gulf of Mexico Outer Continental
Shelf (OCS) Region
Bureau of Ocean Energy
Management (BOEM), Interior.
ACTION: Notice of the Availability of
Environmental Documents Prepared for
OCS Mineral Proposals by the Gulf of
Mexico OCS Region.
AGENCY:

BOEM, in accordance with
Federal Regulations that implement the
National Environmental Policy Act

SUMMARY:

(NEPA), announces the availability of
NEPA-related Site-Specific
Environmental Assessments (SEAs) and
Findings of No Significant Impact
(FONSIs). These documents were
prepared during the period April 1,
2013, through June 30, 2013, for oil, gas,
and mineral-related activities that were
proposed in the Gulf of Mexico, and are
more specifically described in the
Supplementary Information Section of
this notice.
FOR FURTHER INFORMATION CONTACT:
Bureau of Ocean Energy Management,
Gulf of Mexico OCS Region, Attention:
Public Information Office (GM 250E),
1201 Elmwood Park Boulevard, Room
250, New Orleans, Louisiana 70123–
2394, or by calling 1–800–200–GULF.
SUPPLEMENTARY INFORMATION: BOEM
prepares SEAs and FONSIs for certain
proposals that relate to exploration,
development, production, and transport

Activity/operator

Location

Date

ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR
13–094.
ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR
13–092.
EPL Oil & Gas, Inc., Structure Removal, SEA ES/SR 13–091 ....

Brazos, Block 544, Lease OCS–G 10226, located 31 miles
from the nearest Texas shoreline.
South Timbalier, Block 76, Lease OCS–G 04460, located 25
miles from the nearest Louisiana shoreline.
Eugene Island, Block 247, Lease OCS–G 21111, located 57
miles from the nearest Louisiana shoreline.
Mississippi Canyon, Block 258, Lease OCS–G 24066, located
62 miles from the nearest Louisiana shoreline.
Central Planning Area of the Gulf of Mexico ..............................

01–Apr–13.

LLOG Exploration Offshore, L.L.C., Exploration Plan, SEA R–
5839.
EMGS Americas LP, Geological & Geophysical Survey, SEA
L13–004.
Walter Oil & Gas Corporation, Exploration Plan, SEA R–5840 ....
Chevron U.S.A. Inc., Geological & Geophysical Survey, SEA
L13–003.
Pisces Energy LLC, Structure Removal, SEA ES/SR 11–330 &
11–331.
McMoRan Oil & Gas LLC, Structure Removal, SEA ES/SR 13–
084.
Shell Offshore Inc., Exploration Plan, SEA R–5856 .....................
Chevron U.S.A. Inc., Exploration Plan, SEA R–5845 ...................
TESLA Offshore, LLC, Geological & Geophysical Survey, SEA
L13–008.
ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR
13–095.
Anadarko Petroleum Corporation, Exploration Plan, SEA R–
5853.
White Oak Operating Company, L.L.C., Structure Removal, SEA
ES/SR 13–105.
Fairfield Nodal, Geological & Geophysical Survey, SEA L12–003
Energy XXI GOM, LLC, Structure Removal, SEA ES/SR 13–074
Hilcorp Energy GOM, LLC, Structure Removal, SEA ES/SR 13–
101.
Pisces Energy LLC, Structure Removal, SEA ES/SR 13–100 .....
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of oil, gas, and mineral resources on the
Federal OCS. These SEAs examine the
potential environmental effects of
proposed activities and present BOEM
conclusions regarding the significance
of those effects. The SEAs are used as
a basis for determining whether or not
approval of the proposals constitutes a
major Federal action that significantly
affects the quality of the human
environment in accordance with NEPA
Section 102(2)(C). A FONSI is prepared
in those instances where BOEM finds
that approval will not result in
significant effects on the quality of the
human environment. The FONSI briefly
presents the basis for that finding and
includes a summary or copy of the SEA.
This notice constitutes the public
notice of availability of environmental
documents as required under the NEPA
Regulations.

Cobalt International Energy, L.P., Exploration Plan, SEA R–5848
Century Exploration New Orleans, LLC, Structure Removal, SEA
ES/SR 11–046.
Shell Offshore Inc., Development Operations Coordination Document, SEA R–5746.
Century Exploration New Orleans, LLC, Structure Removal, SEA
ES/SR 10–194.

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01–Apr–13.
02–Apr–13.
02–Apr–13.
04–Apr–13.

Central Planning Area of the Gulf of Mexico ..............................
Central Planning Area of the Gulf of Mexico, located 198 miles
from the nearest shoreline.
Eugene Island, Block 53, Lease OCS–G 00479, located 14
miles from the nearest Louisiana shoreline.
West Cameron, Block 294, Lease OCS–G 04090, located 28
miles from the nearest Louisiana shoreline.
Central Planning Area of the Gulf of Mexico, located 82 miles
south of the nearest Louisiana shoreline.
Central Planning Area of the Gulf of Mexico, located 221 miles
south of the nearest Louisiana shoreline.
Central Planning Ares of the Gulf of Mexico ...............................

04–Apr–13.
04–Apr–13.

South Timbalier, Block 77, Lease OCS–G 04827, located 19
miles from the nearest Louisiana shoreline.
Central Planning Area of the Gulf of Mexico, located 224 miles
from the nearest Louisiana shoreline.
Chandeleur, Block 3, Lease OCS–G 25041, located 4 miles
from the nearest Louisiana shoreline.
Main Pass & Mississippi Canyon in the Central Planning Area
of the Gulf of Mexico.
South Timbalier, Block 21, Lease OCS 00263, located 5 miles
from the nearest Louisiana shoreline.
Vermilion, Block 39, Lease OCS 00206, located 10 miles from
the nearest Louisiana shoreline.
West Cameron, Block 081, Lease OCS–G 01477, located 24
miles from the nearest Louisiana shoreline.
Central Planning Area of the Gulf of Mexico, located 137 miles
south of the nearest Louisiana shoreline.
West Cameron, Block 369, Lease OCS–G 00301, located 58
miles from the nearest Louisiana shoreline.
Mississippi Canyon, Block 934, Lease OCS–G 07975, located
61 miles from the nearest Louisiana shoreline.
Ship Shoal, Block 153, Lease OCS–G 18011, located 29 miles
from the nearest Louisiana shoreline.

09–Apr–13.

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11–Apr–13.
11–Apr–13.
11–Apr–13.
11–Apr–13.
15–Apr–13.
15–Apr–13.
17–Apr–13.
17–Apr–13.


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