Washington Administrative Code › Title 173 - Ecology, Department of (See also Titles 197, 317, 372, and 508) › Chapter 173-360A - Underground storage tank regulations › Part 10 - FINANCIAL RESPONSIBILITY › Section 173-360A-1080 - Appendix A-Letter from chief financial officer

Current through Register Vol. 24-14, July 15, 2024
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 remedial action"
				  and/or "compensating third parties 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] 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 WAC 173-360A-0200.]
A [insert: "financial test," and/or "guarantee"] is also used
				  by this [insert: "owner or operator," or "guarantor"] to demonstrate evidence
				  of financial responsibility in the following amounts under other U.S.
				  Environmental Protection Agency (EPA) regulations or state programs authorized
				  by EPA under 40 C.F.R. 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)
						  .......................................................
$________
Authorized State Programs
Amount
Closure
						  ...............................................................................
$________
Post-Closure Care
						  ......................................................................
$________
Liability Coverage
						  ......................................................................
$________
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
				  WAC 173-360A-1060(2)(a) are being used to demonstrate compliance with the
				  financial test requirements. Fill in the information for Alternative II if the
				  criteria of WAC 173-360A-1060(2)(b) are being used to demonstrate compliance
				  with the financial test requirements.]
Alternative I
1.
Amount of annual UST aggregate coverage
						  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]
$_____
7.
Is line 6 at least $10 million?
Yes ___
No ___
8.
Is line 6 at least 10 times line 3?
Yes ___
No ___
9.
Have financial statements for the latest
						  fiscal year been filed with the U.S. Securities and Exchange Commission?
Yes ___
No ___
10.
Have financial statements for the latest
						  fiscal year been filed with the Energy Information Administration?
Yes ___
No ___
11.
Have financial statements for the latest
						  fiscal year been filed with the Rural Utilities Service?
Yes ___
No ___
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]
Yes ___
No ___
Alternative II
1.
Amount of annual UST aggregate coverage
						  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]
$_____
7.
Total assets in the U.S. [required only if
						  less than 90 percent of assets are located in the U.S.]
$_____
8.
Is line 6 at least $10 million?
Yes ___
No ___
9.
Is line 6 at least 6 times line 3?
Yes ___
No ___
10.
Are at least 90 percent of assets located
						  in the U.S.? [If "No," complete line 11]
Yes ___
No ___
11.
Is line 7 at least 6 times line 3?
Yes ___
No ___
[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 6 times line 3?
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 U.S. Securities and Exchange Commission, 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.]
Yes ___
No ___
[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 WAC 173-360A-1080 as such regulations were
				  constituted on the date shown immediately below.
[Signature]
[Name]
[Title]
[Date]
Reviser's note:
The brackets and enclosed
					 material in the text of the above section occurred in the copy filed by the
					 agency and appear in the Register pursuant to the requirements of
					 RCW
					    34.08.040.