New Mexico Administrative Code › Title 20 - ENVIRONMENTAL PROTECTION › Chapter 5 - PETROLEUM STORAGE TANKS › Part 117 - FINANCIAL RESPONSIBILITY › Section 20.5.117.1755 - FORM DOCUMENTS FOR FINANCIAL TEST OF SELF INSURANCE

Current through Register Vol. 35, No. 13, July 16, 2024
To demonstrate that it meets the financial test under
				  Subsection B or C of 20.5.117.1705 NMAC, the chief financial officer of the
				  owner or operator, or guarantor, shall sign, within 120 days of the close of
				  each financial reporting year, as defined by the 12-month period for which
				  financial statements used to support the financial test are prepared, a letter
				  worded exactly as follows, except that the instructions in brackets are to be
				  replaced by the relevant information and the brackets deleted:
LETTER FROM CHIEF FINANCIAL
								OFFICER
I am the chief financial officer of [insert: name
								and address of the owner or operator, or guarantor]. This letter is in support
								of the use of [insert: "the financial test of self-insurance," or "guarantee"]
								to demonstrate financial responsibility for [insert: "taking corrective action"
								and/or "compensating third parties for bodily injury and property damage"]
								caused by [insert: "sudden accidental releases" or "non-sudden accidental
								releases" or "accidental releases"] in the amount of at least [insert: dollar
								amount] per occurrence and [insert: dollar amount] annual tank assured by this
								financial test by the tank identification number provided in the notification
								submitted pursuant to 20.5.102.202 NMAC. If this financial test is used to
								assure both underground and above ground storage tanks, identify each tank as
								underground or above ground and list the tank identification number provided in
								the notification submitted pursuant to 20.5.102.202 NMAC.]
A [insert: "financial test," and/or "guarantee"] is
								also used by this [insert: "owner or operator," or aggregate arising from
								operating (an) underground storage tank(s) and at least [insert dollar amount]
								per occurrence and [insert: dollar amount] annual aggregate arising from
								operating (an) above ground storage tank(s).
Storage tanks at the following facilities are
								assured by this financial test by this [insert: "owner or operator," and/or
								"guarantor"]: [List for each facility: the name and address of the facility
								where tanks assured by this financial test are located, and whether tanks are
								assured by this financial test or another financial test under 20.5.117 New
								Mexico Administrative Code (NMAC). If separate mechanisms or combinations of
								mechanisms are being used to assure any of the tanks at this facility, list
								each "guarantor"] to demonstrate evidence of financial responsibility in the
								following amounts under other EPA regulations or state programs authorized by
								EPA under 40 CFR Parts 271 and 145:
EPA Regulations Amount
Closure (264.143 and 265.143) $______
Post-Closure Care (264.145 and 265.145)
								$______
Liability Coverage (264.147 and 265.147)
								$______
Corrective Action (264.101(b)) $______
Plugging and Abandonment (144.63) $______
Closure $______
Post-Closure Care $______
Liability Coverage $______
Corrective Action $______
Plugging and Abandonment $______
Total $______
This [insert: "owner or operator," or "guarantor"]
								has not received an adverse opinion, a disclaimer of opinion, or a "going
								concern" qualification from an independent auditor on his financial statements
								for the latest completed fiscal year.
[Fill in the information for Alternative I if the
								criteria of Subsection B of 20.5.117.1705 NMAC are being used to demonstrate
								compliance with the financial test requirements. Fill in the information for
								Alternative II if the criteria of Subsection C of 20.5.117.1705 NMAC are being
								used to demonstrate compliance with the financial test requirements.]
Alternative I
1. Amount of annual aggregate coverage for storage
								tanks being assured by a financial test, and/or guarantee $______
2. Amount of corrective action, closure and
								post-closure care costs, liability coverage, and plugging and abandonment costs
								covered by a financial test, and/or guarantee $______
3. Sum of lines 1 and 2 $______
4. Total tangible assets $______
5. Total liabilities [if any of the amount reported
								on line 3 is included in total liabilities, you may deduct that amount from
								this line and add that amount to line 6] $______
6. Tangible net worth [subtract line 5 from line 4]
								$______
Yes No
7. Is line 6 at least $10,000,000? ___ ___
8. Is line 6 at least 10 times line 3? ___
								___
9. Have financial statements for the latest fiscal
								year been filed with the Securities and Exchange Commission? ___ ___
10. Have financial statements for the latest fiscal
								year been filed with the Energy Information Administration? ___ ___
11. Have financial statements for the latest fiscal
								year been filed with the Rural Utilities Service? ___ ___
12. Has financial information been provided to Dun
								and Bradstreet, and has Dun and Bradstreet provided a financial strength rating
								of 4A or 5A? [Answer "Yes" only if both criteria have been met.] ___ ___
Alternative II
1. Amount of annual aggregate coverage for storage
								tanks being assured by a financial test, and/or guarantee $______
2. Amount of corrective action, closure and
								post-closure care costs, liability cover-age, and plugging and abandonment
								costs covered by a financial test, and/or guarantee $______
3. Sum of lines 1 and 2 $______
4. Total tangible assets $______
5. Total liabilities [if any of the amount reported
								on line 3 is included in total liabilities, you may deduct that amount from
								this line and add that amount to line 6] $______
6. Tangible net worth [subtract line 5 from line 4]
								$______
7. Total assets in the U.S. [required only if less
								than 90 percent of assets are located in the U.S.] $______
Yes No
8. Is line 6 at least $10,000,000? ___ ___
9. Is line 6 at least 6 times line 3? ___
								___
10. Are at least 90 percent of assets located in
								the U.S.? ___ ___
[If "No," complete line 11.]
11. Is line 7 at least 6 times line 3? ___
								___
[Fill in either lines 12-15 or lines 16-18:]
12. Current assets $______
13. Current liabilities $______
14. Net working capital [subtract line 13 from line
								12] $______
Yes No
15. Is line 14 at least 6 times line 3? ___
								___
16. Current bond rating of most recent bond issue
								___ ___
17. Name of rating service
								______________________
18. Date of maturity of bond
								______________________
Yes No
19. Have financial statements for the latest fiscal
								year been filed with the SEC, the Energy Information Administration, or the
								Rural Utilities Service? ___ ___
[If "No," please attach a report from an
								independent certified public accountant certifying that there are no material
								differences between the data as reported in lines 4-18 above and the financial
								statements for the latest fiscal year.]
For both Alternative I and Alternative II complete
								the certification with this statement:
I hereby certify that the wording of this letter is
								identical to the wording specified in 20.5.117.1755 NMAC as such regulations
								were constituted on the date shown immediately below.
[Signature]
[Name]
[Title]
[Date]