Virginia Administrative Code › Title 9 - ENVIRONMENT › Agency 25 - STATE WATER CONTROL BOARD › Chapter 640 - ABOVEGROUND STORAGE TANK AND PIPELINE FACILITY FINANCIAL RESPONSIBILITY REQUIREMENTS › Section 9VAC25-640-250:1 - APPENDIX I. LETTER FROM CHIEF FINANCIAL OFFICER

Current through Register Vol. 40, No. 24, July 15, 2024
(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 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 the containment and clean up of discharges of oil
				  in the amount of at least [insert: dollar amount] per occurrence and [insert:
				  dollar amount] annual aggregate arising from operating [insert: "(an)
				  aboveground storage tank(s)" and/or "(a) pipeline(s)"].
Aboveground storage tanks at the following facilities and/or
				  pipelines are assured by this financial test by this [insert: "operator" and/or
				  "guarantor"]:
[List for each facility: the name and address of the facility
				  where tanks assured by this financial test are located, either the registration
				  identification number assigned by the Department or the Oil Discharge
				  Contingency Plan facility identification number, 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.
List for each pipeline: the home office address and the names
				  of the cities and counties in the Commonwealth where the pipeline is
				  located.]
This [insert: "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 fiscal year.
[Fill in the information for Alternative I if the criteria of
				  9VAC25-640-70 B are being used to
				  demonstrate compliance with the financial test requirements. Fill in the
				  information for Alternative II if the criteria of
				  9VAC25-640-70 C are being used to
				  demonstrate compliance with the financial test requirements.]
ALTERNATIVE I
1. Amount of AST annual aggregate coverage being assured
						  by a financial test, and/or guarantee
$_________
2. Amount of pipeline annual aggregate coverage covered
						  by a financial test, and/or guarantee
$_________
3. Amount of annual underground storage tank (UST)
						  aggregate coverage being assured by a financial test and/or guarantee pursuant
						  to 9 VAC 25-590
$_________
4. Total AST/Pipeline/UST financial responsibility
						  obligations assured by a financial test and/or guarantee (Sum of lines 1, 2 and
						  3)
$_________
5. Total tangible assets
$_________
6. Total liabilities [if any of the amount reported on
						  line 4 is included in total liabilities, you may deduct that amount from this
						  line or add that amount to line 7]
$_________
7. Tangible net worth [subtract line 6 from line 5]
$_________
8. Is line 7 at least equal to line 4 above
Yes
No
___
___
9. Have financial statements for the latest financial
						  reporting year been filed with the Securities and Exchange Commission
___
___
10. Have financial statements for the latest financial
						  reporting year been filed with the Energy Information Administration
___
___
11. Have financial statements for the latest financial
						  reporting 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
						  at least equal to the amount of annual AST/pipeline aggregate coverage being
						  assured [Answer Yes only if both criteria have been met.]
___
___
13. If you did not answer Yes to one of lines 9 through
						  12, please attach a report from an independent certified public accountant
						  certifying that there are no material differences between the data reported in
						  lines 5 through 8 above and the financial statements for the latest financial
						  reporting year.
ALTERNATIVE II
1. Amount of AST annual aggregate coverage being assured
						  by a financial test, and/or guarantee
$_________
2. Amount of pipeline annual aggregate coverage covered
						  by a financial test, and/or guarantee
$_________
3. Amount of annual underground storage tank (UST)
						  aggregate coverage being assured by a financial test and/or guarantee pursuant
						  to 9VAC25-590
$_________
4. Total AST/PipelineUST financial responsibility
						  obligations assured by a financial test and/or guarantee (Sum of lines 1, 2 and
						  3)
$_________
5. Total tangible assets
$_________
6. Total liabilities [if any of the amount reported on
						  line 4 is included in total liabilities, you may deduct that amount from this
						  line or add that amount to line]
$_________
7. Tangible net worth [subtract line 6 from line 5]
$_________
8. Total assets in the U.S. [required only if less than
						  90 percent of assets are located in the U.S.]
$_________
9. Is line 7 at least equal to line 4 above
Yes
No
___
___
10. Are at least 90 percent of assets located in the
						  U.S. [If No, complete line 11.]
___
___
11. Is line 8 at least equal to line 4
___
___
[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]
$_________
15. Is line 14 at least equal to line 4
Yes
No
___
___
16. Current bond rating of most recent bond issue
__________
17. Name of rating service
__________
18. Date of maturity of bond
__________
19. Have financial statements for the latest
						  fiscal year been filed with the SEC, the Energy Information Administration, or
						  the Rural Utilities Service
Yes
No
___
___
[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 5-18 above and the financial statements
				  for the latest financial reporting year.]
[For Alternatives I and II, complete the certification with
				  this statement.]
I hereby certify that the wording of this letter is identical
				  to the wording specified in Appendix I of 9VAC25-640 as such regulations were
				  constituted on the date shown immediately below.
[Signature]
[Name]
[Title]
[Date]
Statutory Authority
§§ 62.1-44.15 and 62.1-44.34:16 of the Code of
					 Virginia.