Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47723 

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 

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 

AGENCY: Bureau of Land Management, 

Interior. 

ACTION: Notice of Public Meeting. 

SUMMARY: 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, 

mark_jacobsen@blm.gov. 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 

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 15- 

member 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. 

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

BILLING CODE 4310–DN–P 

DEPARTMENT OF THE INTERIOR 

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. 

SUMMARY: 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. 


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47724 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 

DATES: 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 

arlene.bajusz@boem.gov (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 60- 

day 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. 

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 

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 47725 

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 

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 

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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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: 

Form BOEM-1016, DeSignated Applicant Information Certification ....................... 1 hour 

Form BOEM-1017, AppOintment of DeSignated Applicant ............ ., ............ ., ..... 9 hours 

Form BOEM-1 018, Self-Insurance Information ................................................... 1 hour 

Form BOEM-1019, Insurance Certificate ........................................................ 120 hours 

Form BOEM-1020, Surety Bond ...................................................................... 24 hours 

Form BOEM-1 021, Covered Offshore Facilities ................................................... 6 hours 

Form BOEM-1022, Covered Offshore Facility Changes ........................................ 1 hour 

Form BOEM-1023, Financial Guarantee ............................. 1.5 hours 

Form BOEM-1025, 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) 
Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47727 


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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: _________ ---:==~=~=------- 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 

• 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 

TITLE OF AUTHORIZED REPRESENTATIVE 

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

( ) 

AREA CODE and TELEPHONE NUMBER 

FORM BOEM-1016 (Monthlyear) 

Previous Editions are Obsolete. 

ADDRESS 

CITY 

( ) 

AREA CODE and FAX NUMBER 

SIGNATURE 

DATE 

NAME 

BOEM COMPANY NUMBER 

STATE ZIP CODE 

E-MAIL ADDRESS 

PAGE 1 OF 1 
47728 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 


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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 ZIP CODE 

CONTACT PERSON 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 

TITLE OF AUTHORIZED REPRESENTATIVE 

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

( ) 

AREA CODE and TELEPHONE NUMBER 

FORM BOEM-1017 (MonthNear) 

Previous Editions are Obsolete. 

ADDRESS 

CITY 

( ) 

AREA CODE and FAX NUMBER 

SIGNATURE 

DATE 

NAME 

BOEM COMPANY NUMBER 

STATE ZIP CODE 

E·MAIL ADDRESS 

PAGE 1 OF 2 
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5. Locations of Covered Offshore Facilities: 

STAte ..••.. 'i .... I;)R LEASE 

QCS '<l\Iti.B~R RI;GlON ... i, . i .•• 

Al'9IJO~ 

PQRn~N 

tlf~I!l>~~bl~l 

FORM BOEM·1017 (Month/year) 

Previous Editions are Obsolete. 

. DEPTH 

RANGE 

(lfA'pl>lj.cabl~)< 

P:1~El.I tfE SE~lvl~~~ 

IIIUMBER···· 

PAGE20F 2 
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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 [ I TO 

$ 

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. 

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. 

FORM BOEM-1018 (MonthNear) 

Previous Editions are Obsolete. 

PAGE 1 OF2 
Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47731 


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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 

TITLE OF AUTHORIZED REPRESENTATIVE OF 

RESPONSIBLE PARTY 

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

NAME 

ADDRESS 

AREA CODE AND TELEPHONE NUMBER AREA CODE AND FAX NUMBER 

SIGNATURE 

DATE 

BOEM COMPANY 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 

FORM BOEM-1018 (MonthlYear) 

Previous Editions are Obsolete. 

PAGE20F2 
47732 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 


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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 $.--:::==~=~=~;-­ STARTING AMOUNT ABOVE ANY 

DEDUCTIBLE OR EXCESS AMOUNT 

TO:$--~U~P~P~ER~L~IM~IT~O~F~---­ 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 and expires: ___ ::-::-:::=-__ 

DATE 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. 

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. 

FORM BOEM-1019 (MonthNear) 

Previous Editions are Obsolete. 

PAGE 1 OFS 
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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 COUNTRY (Ifnot U.S.A.) ZIP CODE 

( ) ( ) 

AREA CODE and TELEPHONE NUMBER AREA CODE and FAX NUMBER E-MAIL ADDRESS 

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 

FORM BOEM-1019 (MonthlY ear) 

Previous Editions are Obsolete. 

DATE 

PAGE 2 OF 5 
47734 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 


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

Certificate: 

NAME BOEM COMPANY NUMBER 

ADDRESS 

CITY STATE 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 

CITY 

FORM BOEM-1019 (MonthNear) 

Previous Editions are Obsolete, 

STATE ZIP CODE 

PAGE 3 OF 5 
Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47735 


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PAGE40F5 
47736 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 


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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 , and 

NAME OF SURETY COMPANY 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 

Pollution Act of 1990, 33 U.S. C. § 2701 et seq. (hereinafter called Act), in the sum of $ , for 

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 -:-:-::=.,----' ----::-;:-.:-::,--' 12:01 a.m., Eastern Standard Time 

NUMBER MONTH YEAR 

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. 

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. 

FORM BOEM-1020 (Monthlyear) 

Previous Editions are Obsolete. 

PAGE 1 OF2 
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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 

TITLE OF AUTHORIZED REPRESENTATIVE 

FORM BOEM-1020 (Month/year) 

Previous Editions are Obsolete. 

PAGE20F2 
47738 Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 


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U.S. Department of the Interior 

Bureau of Ocean Energy Management 

COVERED OFFSHORE FACILITIES 

OMB Control No.: xxxxxxx 

Expiration Date: xxxxxxx 

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 

TITLE 

3. Locations of covered offshore facilities: 

FORM BOEM-1021 (MonthlYear) 

Previous Editions are Obsolete. 

SIGNATURE OF AUTHORIZED REPRESENTATIVE 

DATE 

PAGE 1 OF2 
Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47739 


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3. Locations of covered offshore facilities (continued): 

RUEor 

POTENTIAL 

STATE ALIQUOT PIPELINE WORST 

OR LEASE PORTION AREA BLOCK PERMIT ROW SEGMENT CASE OIL· 

NUMBER NAME NUMBER NUMBER NUMBER SPILL OCSREGION (If Applicable) NUMBER DISCHARGE 

(In Barrels) 

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

FORM BOEM-1021 (MonthIYear) 

Previous Editions are Obsolete. 

PAGE20F 2 
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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 

NAME OF AUTHORIZED REPRESENTATIVE SIGNATURE OF AUTHORIZED REPRESENTATNE 

TITLE DATE 

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

StATE ..... 

I<:;>R l.EASE 

i ....... 

AI.IQUQT AREA 

PORTION .... NAME 

(If Applicablet) 

..•. 

IilLOCK 

.· .. NuN1SI:~ 

. '. . '., POTENTIAl;, 

~IPEl.IN~ .' W<?rt$T 

PERMI,. \ I RUE OR '.' SEGMENT I~SE.OIl.i' 

TY~EOF 

CHANGE I oeg NUMBER 

REGION .'. . 

NUMBER ROW.' .... .. SPILt. 

I ... NUMBER NUNlBE~ PI.SCl:IARGE 

.'. .• . .' '. .... • .. " • . .'. .. (lnB~rrelsr 

...... 

<'NO/III) .... .•.• I···· 

*A = Addition, D = Deletion, and N = New Potential Worst Case Oil Spill 

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

FORM BOEM-1022 (MonthNear) 

Previous Editions are Obsolete. 

PAGE 1 OF 1 
Federal Register / Vol. 78, No. 151 / Tuesday, August 6, 2013 / Notices 47741 


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U.S. Department of the Interior 

Bureau of Ocean Energy Management 

FINANCIAl..; GUARANTEE 

OMB Control No.: xxxxxxx 

Expiration Date: xxxxxxx 

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 

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. 

FORM BOEM·1023 (MonthNear) 

Previous Editions are Obsolete. 

PAGE 1 OF4 
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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 TELEPHONE NUMBER AREA CODE AND FAX 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 

TITLE 

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

NAME 

CITY 

AREA CODE AND TELEPHONE NUMBER 

FORM BOEM-1023 (MonthNear) 

Previous Editions are Obsolete. 

ADDRESS 

STATE 

AREA CODE AND FAX NUMBER 

SIGNATURE 

DATE 

BOEM COMPANY NUMBER 

ZIP CODE 

E-MAIL ADDRESS 

PAGE20F4 
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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 

TITLE 

FORM BOEM-1023 (MonthlYear) 

Previous Editions are Obsolete. 

PAGE30F4 
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~~~~~~ RESPONSIBLE PARTIES COVERED BY THIS AGREEMENT 

FORM BOEM·1023 (MonthlYear) 

Previous Editions are Obsolete. 

PAGE40F4 
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U.S. Department of the Interior 

Bureau of Ocean Energy Management 

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 

TITLE OF AUTHORIZED REPRESENTATIVE OF DESIGNATED APPLICANT 

FORM BOEM-1025 (Month/year) 

Previous Editions are Obsolete. 

SIGNATURE 

DATE 

PAGE 1 OF 1 
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 

AGENCY: 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. 

SUMMARY: BOEM, in accordance with 

Federal Regulations that implement the 

National Environmental Policy Act 

(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 

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. 

Activity/operator Location Date 

ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR 

13–094.

Brazos, Block 544, Lease OCS–G 10226, located 31 miles 

from the nearest Texas shoreline.

01–Apr–13. 

ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR 

13–092.

South Timbalier, Block 76, Lease OCS–G 04460, located 25 

miles from the nearest Louisiana shoreline.

01–Apr–13. 

EPL Oil & Gas, Inc., Structure Removal, SEA ES/SR 13–091 .... Eugene Island, Block 247, Lease OCS–G 21111, located 57 

miles from the nearest Louisiana shoreline.

02–Apr–13. 

LLOG Exploration Offshore, L.L.C., Exploration Plan, SEA R– 

5839.

Mississippi Canyon, Block 258, Lease OCS–G 24066, located 

62 miles from the nearest Louisiana shoreline.

02–Apr–13. 

EMGS Americas LP, Geological & Geophysical Survey, SEA 

L13–004.

Central Planning Area of the Gulf of Mexico .............................. 04–Apr–13. 

Walter Oil & Gas Corporation, Exploration Plan, SEA R–5840 .... Central Planning Area of the Gulf of Mexico .............................. 04–Apr–13. 

Chevron U.S.A. Inc., Geological & Geophysical Survey, SEA 

L13–003.

Central Planning Area of the Gulf of Mexico, located 198 miles 

from the nearest shoreline.

04–Apr–13. 

Pisces Energy LLC, Structure Removal, SEA ES/SR 11–330 & 

11–331.

Eugene Island, Block 53, Lease OCS–G 00479, located 14 

miles from the nearest Louisiana shoreline.

04–Apr–13. 

McMoRan Oil & Gas LLC, Structure Removal, SEA ES/SR 13– 

084.

West Cameron, Block 294, Lease OCS–G 04090, located 28 

miles from the nearest Louisiana shoreline.

04–Apr–13. 

Shell Offshore Inc., Exploration Plan, SEA R–5856 ..................... Central Planning Area of the Gulf of Mexico, located 82 miles 

south of the nearest Louisiana shoreline.

05–Apr–13. 

Chevron U.S.A. Inc., Exploration Plan, SEA R–5845 ................... Central Planning Area of the Gulf of Mexico, located 221 miles 

south of the nearest Louisiana shoreline.

08–Apr–13. 

TESLA Offshore, LLC, Geological & Geophysical Survey, SEA 

L13–008.

Central Planning Ares of the Gulf of Mexico ............................... 08–Apr–13. 

ATP Oil & Gas Corporation, Structure Removal, SEA ES/SR 

13–095.

South Timbalier, Block 77, Lease OCS–G 04827, located 19 

miles from the nearest Louisiana shoreline.

09–Apr–13. 

Anadarko Petroleum Corporation, Exploration Plan, SEA R– 

5853.

Central Planning Area of the Gulf of Mexico, located 224 miles 

from the nearest Louisiana shoreline.

10–Apr–13. 

White Oak Operating Company, L.L.C., Structure Removal, SEA 

ES/SR 13–105.

Chandeleur, Block 3, Lease OCS–G 25041, located 4 miles 

from the nearest Louisiana shoreline.

11–Apr–13. 

Fairfield Nodal, Geological & Geophysical Survey, SEA L12–003 Main Pass & Mississippi Canyon in the Central Planning Area 

of the Gulf of Mexico.

11–Apr–13. 

Energy XXI GOM, LLC, Structure Removal, SEA ES/SR 13–074 South Timbalier, Block 21, Lease OCS 00263, located 5 miles 

from the nearest Louisiana shoreline.

11–Apr–13. 

Hilcorp Energy GOM, LLC, Structure Removal, SEA ES/SR 13– 

101.

Vermilion, Block 39, Lease OCS 00206, located 10 miles from 

the nearest Louisiana shoreline.

11–Apr–13. 

Pisces Energy LLC, Structure Removal, SEA ES/SR 13–100 ..... West Cameron, Block 081, Lease OCS–G 01477, located 24 

miles from the nearest Louisiana shoreline.

11–Apr–13. 

Cobalt International Energy, L.P., Exploration Plan, SEA R–5848 Central Planning Area of the Gulf of Mexico, located 137 miles 

south of the nearest Louisiana shoreline.

15–Apr–13. 

Century Exploration New Orleans, LLC, Structure Removal, SEA 

ES/SR 11–046.

West Cameron, Block 369, Lease OCS–G 00301, located 58 

miles from the nearest Louisiana shoreline.

15–Apr–13. 

Shell Offshore Inc., Development Operations Coordination Document, SEA R–5746.Mississippi Canyon, Block 934, Lease OCS–G 07975, located 

61 miles from the nearest Louisiana shoreline.

17–Apr–13. 

Century Exploration New Orleans, LLC, Structure Removal, SEA 

ES/SR 10–194.

Ship Shoal, Block 153, Lease OCS–G 18011, located 29 miles 

from the nearest Louisiana shoreline.

17–Apr–13. 


tkelley on DSK3SPTVN1PROD with NOTICES