Virginia Administrative Code › Title 9 - ENVIRONMENT › Agency 25 - STATE WATER CONTROL BOARD › Chapter 590 - PETROLEUM UNDERGROUND STORAGE TANK FINANCIAL RESPONSIBILITY REQUIREMENTS › Section 9VAC25-590-260:11 - APPENDIX XI. LETTER FROM CHIEF FINANCIAL OFFICER (SHORT FORM)

Current through Register Vol. 40, No. 24, July 15, 2024
Note: This Appendix may only be used by owners or operators
				  who do not own or operate hazardous waste facilities, or underground injection
				  control wells.
Note: The instructions in brackets are to be replaced by the
				  relevant information and the brackets deleted.
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," and/or "Guarantee" to
				  demonstrate financial responsibility for insert: "taking corrective action"
				  and/or "compensating third "part"ies for bodily injury and property damage"
				  caused by insert "sudden accidental releases" or "nonsudden accidental
				  releases" or "accidental releases" in the amount of at least $insert dollar
				  amount corrective action per occurrence, $insert dollar amount third "part"y
				  liability per occurrence, and $insert dollar amount annual aggregate arising
				  from operating (an) underground storage tank(s).
Underground storage tanks at the following facilities are
				  assured by this financial test by this insert: "owner or operator," and/or
				  "guarantor": List for each facility the name and address of the facility where
				  tanks assured by this financial test are located, and whether tanks are assured
				  by this financial test. If separate mechanisms or combinations of mechanisms
				  are being used to assure any of the tanks at this facility, list each tank
				  assured by this financial test by the tank identification number provided in
				  the notification submitted pursuant to
				  9VAC25-580-70 (Underground Storage
				  Tanks: Technical Standards and Corrective Action Requirements).
I am not required to demonstrate evidence of financial
				  responsibility for any other EPA regulation or state programs authorized by
				  EPA.
This insert: "owner or operator," or "guarantor" has not
				  received an adverse opinion, a disclaimer of opinion, or a "going concern"
				  qualification from an independent auditor on the financial statements for the
				  latest completed financial reporting year.
Fill in the information below to demonstrate compliance with
				  the financial test requirements.
1.
				Amount of annual UST aggregate coverage being assured by a financial test,
				and/or guarantee...$__________
2.
				Amount of annual aboveground storage tank (AST) aggregate coverage being
				assured by a financial test and/or guarantee...$__________
3. Total UST/AST financial responsibility
				obligations assured by a financial test and/or guarantee (sum of lines 1 and
				2)...$__________
4. Total tangible
				assets...$__________
5. Total
				liabilities if any of the amount reported on line 3 is included in total
				liabilities, you may deduct that amount from this line or add that amount to
				line 6...$__________
6. Tangible
				net worth subtract line 5 from line 4...$__________
7. Is line 4 at least equal to line 3 above?
				Yes... No...
8. Have financial
				statements for the latest financial reporting year been filed with the
				Securities and Exchange Commission? Yes... No...
9. Have financial statements for the latest
				financial reporting year been filed with the Energy Information Administration?
				Yes... No...
10. Have financial
				statements for the latest financial reporting year been filed with the Rural
				Utilities Service? Yes... No...
11.
				Has financial information been provided to Dun and Bradstreet, and has Dun and
				Bradstreet provided a financial strength rating at least equal to the amount of
				annual UST aggregate coverage being assured according to the table below?
Annual Aggregate Requirement
Dun and Bradstreet Rating
$20,000
EE ($20,000 to $34,999)
$40,000
DC ($50,000 to $74,999)
$80,000
CB ($125,000 to $199,999)
$150,000
BB ($200,000 to $299,999)
$200,000
BB ($200,000 to $299,999)
$300,000
BA ($300,000 to $499,999)
$500,000
1A ($500,000 to $749,999)
$750,000
2A ($750,000 to $999,999)
$1,000,000
3A ($1,000,000 to $9,999,999)
Answer "Yes" only if BOTH criteria have been met. Yes...
				  No...
12. If you did not
				answer yes to one of lines 8 through 11, please attach a report from a
				certified public accountant certifying that there are no material differences
				between the data reported in lines 4 through 7 above and the financial
				statements for the latest financial reporting year.
I hereby certify that the wording of this letter is identical
				  to the wording specified in Appendix XI of this chapter as such regulations
				  were constituted on the date shown immediately below.
Signature
Name
Title
Date
Statutory Authority: §§ 62-1.44.15 and
					 62.1-44.34:9 of the Code of
					 Virginia; 42 USC §
												6901 et seq.; 40 CFR "part"s 280 and
					 281.