Form BOEM-1123 Designation of Operator

U.S. Department of the Interior

_{Bureau of Ocean Energy Management}

OMB Control No: 1010-0114

Expiration Date: xx/xx/xxxx

DESIGNATION OF OPERATOR

The person identified below is, on the records of the Bureau of Ocean Energy Management, a lessee and/or operating rights owner of:

Lease Number:

Regional Office:

_{and hereby designates}

Name of Operator:

_Address:

Check here if description continued on attached sheet.

as the designated operator and agent with full authority to act on the lessee’s/operating rights owner’s behalf, to fulfill the lessee’s/operating rights owner’s obligations under the OCS Lands Act, in compliance with the terms and conditions of the lease, laws and applicable regulations. The BOEM Regional Supervisor or the authorized BOEM Regional Officer may provide the designated operator written or oral instructions in securing compliance with the lease, laws, and applicable regulations. This designation of operator is made with respect to (describe block or aliquot portion of the lease’s area and depth, if appropriate, to which this designation applies):

It is understood that this designation of operator does not relieve the lessee/operating rights owner of responsibility for compliance with the terms of the lease, laws, and applicable regulations. It is also understood that this designation of operator does not constitute an assignment of any interest in the lease.

In case of default on the part of the designated operator, the lessee/operating rights owner will make full and prompt compliance with all laws, regulations, lease terms, or orders of the Secretary of the Interior or his/her representative. If BOEM determines the operator’s performance being conducted on the leased area described above is unacceptable, BOEM may disqualify the operator, or may disapprove or revoke your designation of operator. The operator will be given adequate notice and opportunity for a review by BOEM Regional officials before initiating or imposing a disqualification. The BOEM Regional Director may require the lessee/operating rights owner to designate an agent empowered to fulfill the lessee’s/operating rights owner’s obligations under the OCS Lands Act, the lease, or governing regulations.

The lessee/operating rights owner agrees to notify the Regional Supervisor promptly of any change in the designated operator. The designated operator shall comply with the Department of the Interior’s nonprocurement debarment and suspension regulations as required by Subpart A of 2 CFR Part 180 and by Subpart B of 2 CFR Part 1400 and shall communicate the requirement to comply with these regulations to persons with whom it does business related to this designation by including this term in its contracts and transactions.

______________________________________________

Name of Designated Operator

________________________________________

Qualification Number of Operator

By: __________________________________________

Signatory Name:

Signatory Title:

_____________________________________________

Date

­­­­­­­­­­­­­­­­­­_____________________________________________

Name of Lessee/Grantee

________________________________________

Qualification Number of Lessee/Grantee

By: __________________________________________

Signatory Name:

Signatory Title:

_____________________________________________

Date

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BOEM collects this information to be informed of who is authorized to act on behalf of the lessees/operating rights owners to fulfill their obligations under the OCS Lands Act, lease, and applicable regulations, and who is authorized to receive notices and comply with regulatory orders issued. Responses are mandatory (43 U.S.C. 1331 et seq.). No proprietary information is collected. An agency may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Ocean Energy Management, 45600 Woodland Rd, Sterling, VA 20166.

Form BOEM-1123 (Month/Year) Page 1 of 1

Previous Editions are Obsolete.