Nebraska Administrative Code › Topic - ENVIRONMENT AND ENERGY › Title 122 - NEBRASKA DEPARTMENT OF ENVIRONMENTAL QUALITY › Appendix IV - Letter From Chief Financial Officer

Current through June 17, 2024
A letter from the chief financial officer as specified in Chapter 13,
	 §009 of this Title must be worded as follows, except that instructions in
	 brackets are to be replaced with the relevant information and the brackets
	 deleted.
Letter From Chief Financial Officer
{Address to Director, Nebraska Department of Environmental Quality, Box
	 98922,, Lincoln, NE 68509}
I am the chief financial officer of {name and address of firm.} This
	 letter is in support of this firm's use of a bond without surety as financial
	 assurance and to meet the financial test in Title 122, Chapter 13,
	 §
009.01
.
{Fill out the following paragraph regarding injection wells and
	 associated cost estimates. For each injection well, include its name, address,
	 and current EPMC cost estimate.}
This firm is the operator of the following injection wells for which
	 financial assurance for EPMC is demonstrated through the financial test
	 specified in Title 122, Chapter 13, §
009.01
. The
	 current EPMC cost estimate covered by the test is shown for each injection
	 well:
The fiscal year of this firm ends on {month, day}. The figures for the
	 following items marked with an asterisk are derived from this firm's
	 independently audited, year-end financial statements for the latest completed
	 fiscal year ended {date}.
{Fill in Alternative I if the criteria of section
009.01A
of Chapter 13, Title 122 are used. Fill in
	 Alternative II if the criteria of section
009.01B
of
	 the same Chapter and Title are used}.
Alternative I
1. Current EPMC costs.
$__________
*2. Total liabilities {If any portion of the EPMC costs is
			 included in total liabilities, you may deduct the amount of that portion from
			 this line and add that amount to lines 3 and 4}.
$__________
*3. Tangible net worth
$__________
*4. Net worth
$__________
*5. Current assets
$__________
*6. Current liabilities
$__________
*7. Net working capital (line 5 minus line 6)
$__________
*8. The sum of net income plus depreciation, depletion and
			 amortization
$__________
*9. Total assets in U.S. (required only if less than 90% of firm's
			 assets are located in U.S.)
$__________
Yes
No
10. Is line 3 at least $10 million?
______
______
11. Is line 3 at least 6 times line 1?
______
______
12. Is line 7 at least 6 times line 1?
______
______
13. Are at least 90% of firm's assets located in U.S.? If not,
			 complete line 14.
______
______
14. Is line 9 at least 6 times line 1?
______
______
15. Is line 2 divided by line 4 less than 2.0?
______
______
16. Is line 8 divided by line 2 greater than 0.1?
______
______
17. Is line 5 divided by line 6 greater than 1.5?
______
______
Alternative II
1. Current EPMC $ ___________
2. Current bond rating of most recent issuance of this firm and name of
	 rating service
	 ____________________________________________________________________
3. Date of issuance of bond ________________________________
4. Date of maturity of bond ________________________________
* 5. Tangible net worth {If any portion of the EPMC cost estimate is
	 included in "total liabilities" on your firm's financial statements, you may
	 add the amount of that portion to this line} $ ___________
* 6. Total assets in U.S. (required only if less than 90% of firm's
	 assets are located in U.S.) $ ______
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Yes
No
7. Is line 5 at least $10 million?
_____
_____
8. Is line 5 at least 6 times line 1?
_____
_____
*9. Are at least 90% of firm's assets located in the U.S? If not,
			 complete line 10.
_____
_____
10. Is line 6 at least 6 times line 1?
_____
_____
I hereby certify that the wording of this letter is identical to the
	 wording specified in Title 122, Chapter 13 §
009
as such regulations were constituted on the date shown immediately
	 below.
_______________________________________
{Signature}
_______________________________________
{Name}
_______________________________________
{Title}
_______________________________________
{Date}