U.S.
Department of the Interior Minerals
Management Service
OMB Control No. 1010-0006
OMB Approval Expires: xx/xx/xxxx
Cover Page
OUTER CONTINENTAL SHELF (OCS)
MINERAL LESSEE'S AND OPERATOR'S
SUPPLEMENTAL PLUGGING AND ABANDONMENT BOND
Form MMS-2028A
This form dated Month Year supersedes all previous versions of form MMS-2028A
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that MMS collects this information to hold the surety liable for the obligations and liability of the Principal (lessee or operator). Responses are mandatory to obtain or retain a benefit. No proprietary information is collected. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for this form is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, 1849 C Street, NW, Washington, DC 20240.
U.S. DEPARTMENT OF THE INTERIOR
Minerals Management Service
Bond No._________________________ OCS Lease No. and Area/Block _________________________
Bond Type_________________________ Amount_________________________________
OUTER CONTINENTAL SHELF (OCS) MINERAL LESSEE'S AND OPERATOR'S
SUPPLEMENTAL PLUGGING AND ABANDONMENT BOND
The Surety is the Company Guaranteeing Performance. Name of Surety: ______________________________________________________________ Mailing Address: _____________________________________________________________ _____________________________________________________________ If a Corporation, Incorporated in the State of: _____________________; County or Parish of: ______________________________ ┓Check here if Surety is certified by U.S. Treasury as an acceptable surety on Federal Bonds and listed in the current U.S. Treasury Circular No. 570. |
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The Principal is the Lessee or Operator for Whom the Bond is Issued. Name of Principal: ____________________________________________________________ Mailing Address: ______________________________________________________________ ______________________________________________________________ |
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Schedule A, the area or leases covered by this bond, is composed of: (Check one and add description) ┓ The following Area:____________________________________________________________________________ ┓ The following leases: ___________________________________________________________________________ ___________________________________________________________________________________________ |
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In addition to the Obligations of the Principal during the period of liability of this bond, the Surety also accepts the following Obligations: (Check one) ┓ No Obligations other than the Obligations of the Principal during the period of liability of this bond. ┓ All Obligations of all previous Sureties or guarantors even if the Obligations are not Obligations of the Principal during the period of liability of this bond. ┓ All Obligations of all previous Sureties or guarantors even if the Obligations are not Obligations of the Principal during the period of liability of this bond with the following exceptions or limitations:________________________________________________________ __________________________________________________________________________________(use an attached sheet if needed) |
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Definitions
For the purposes of this document:
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An Obligation includes any obligation arising from any regulations of the Department of the Interior or any Instrument issued, maintained, or approved under the OCS Lands Act (43 U.S.C. 1331 et seq.). An Instrument includes individually or collectively any lease, operating agreement, designation of operator or agent, storage agreement, compensatory royalty agreement, transfer of operating rights, permit, license, or easement, whereunder the Principal has the right, privilege, or license to conduct operations on the OCS. A Person includes an individual, a public or private corporation, a State, a political subdivision of a State, any association of individuals, corporations, States, or subdivisions of States, or a government agency. |
By signing below, the Principal verifies that the information above is correct and agrees to the following: The Principal as agent on behalf of all lessees, operating rights owners, and operators will fulfill all Obligations for the entire leasehold and to the same extent as though the Principal were the sole lessee for all leases in Schedule A or for all leases for which the Principal has an interest within an area designated in Schedule A. |
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By signing below, the Surety verifies that the information above is correct and agrees to the following:
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Form MMS-2028A (March 2004) The Paperwork Reduction Act Statement is printed on the Cover Page. Page 1 of 2
Obligations of the lease in accordance with MMS specifications be materially false and the MMS relied upon such representation in canceling the instrument.
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_____________________________________ Name of Surety
_____________________________________ Signature of Person Executing for Surety
_____________________________________ Name and Title Typed or Printed
_____________________________________ Business Address
_____________________________________ Business Address |
_____________________________________ Name of Principal
_____________________________________ Signature of Person Executing for Principal
_____________________________________ Name and Title Typed or Printed
_____________________________________ Business Address
_____________________________________ Business Address |
Signed on this ________ day of _______________ , 20______, in the State of ____________________, in the presence of:
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_____________________________________ Signature of Witness
_____________________________________ Name Typed or Printed
_____________________________________ Address
_____________________________________ Address |
_____________________________________ Signature of Witness
_____________________________________ Name Typed or Printed
_____________________________________ Address
_____________________________________ Address |
Note: The party signing for the Surety must attach a corporate resolution and power of attorney stating his or her authority to undertake this Obligation, pursuant to the acts of the corporate board of directors and the laws of the State of incorporation. The corporation executing this bond as Surety and the lessee or operator, if a corporation, must affix their corporate seals.
Form MMS-2028A (March 2004) The Paperwork Reduction Act Statement is printed on the Cover Page. Page 2 of 2
File Type | application/msword |
File Title | Form MMS-2028(January 2001) |
Author | mirabelj |
Last Modified By | blundonc |
File Modified | 2007-03-02 |
File Created | 2007-03-02 |