Form 5900-239 TPEM Bond Calculation/Waiver Worksheet

United States

Environmental Protection Agency

Office of Transportation and Air Quality

TPEM Bonding Worksheet

Last Revision: September 3, 2010 Version Number: 3.0

Bond Worksheet for TPEM

Please save this file with the title "TPEM worksheet XXXXXXXX20MY.xls" where XXXXXXXX is your company's name and 20MY is actually the Model Year that this Bond Worksheet represents. All fields highlighted in yellow are CBI. According to §1039.626 and §1054.626, as an equipment manufacturer using the provisions of §1039.625 and §1054.625 for equipment produced outside the United States, you may be required to post a bond to cover any potential enforcement actions under the Clean Air Act before you or anyone else imports your equipment with exempted engines. To determine whether you are required to post a bond, complete the Long-Term Asset Test in the Bonding Worksheet. The Long-Term Asset Test is based on the value of buildings, land, and fixed equipment from your most recent balance sheet, minus depreciation and long-term liabilities (such as mortgage). The value of the fixed assets are for the whole company, including any parent or subsidiary companies. If you do need to post a bond based on the Long-Term Asset Test, complete the Bond Value Calculation section of the Bonding Worksheet to determine the value of the bond. If your estimated or actual engine imports increase beyond the level appropriate for your current bond payment, you must post additional bond to reflect the increased sales within 90 days after you change your estimate or determine the actual sales. You may not decrease your bond.

THIS WORKSHEET CONTAINS CBI!

Worksheet Filer's Name:

Worksheet Filer's Parent Company Name:

Certificate Holder's Name:

Equipment Manufacturer's Name:

Yes

Long-term Asset Test

CBI: Identify the asset threshold that applies to your company.

$10,000,000

$6,000,000

For secondary engine manufacturers. Identify the company that supplies your engines:

$3,000,000

For manufacturers that have held a certificate for each of the last 10 years with no finding of noncompliance.

CBI: Identify your level of fixed assets in the United States minus depreciation and related long-term liabilities.

Less than $3,000,000

At least $3,000,000 but less than $6,000,000

At least $6,000,000 but less than $10,000,000

$10,000,000 or more

Please identify the asset threshold that applies to your comany.

Worksheet Filer's Name:

Long-term Asset Details

Identify the addresses where you have at least that much value of fixed assets (with corresponding photographs), as described below. If you need to add additional locations, please use a second file. Name the file, "Bond worksheet XXXXXXXX-Y.xls where XXXXXXXX is your company's name, and Y is the next sequential letter. For example, the second file is -A, the third file is -B.

Identify all the addresses where your fixed assets are located.

Address 1

Address 2

Address 3

Include a photograph of each facility identified above. (Please embed files)

Address 1

Address 2

Address 3

CBI: Include the following data from the most recent balance sheet. Please include all Capital Leases.

Address 1

Address 2

Address 3

Net PPE

- or -

Total fixed assets

Mortgages on above assets

Accumulated depreciation on above assets

Net Assets

$-

$-

$-

Worksheet Filer's Name:

Bond Value Calculation §1039.626 (Nonroad CI)

If you need to post bond under §1039.626, use the following worksheet to calculate the value of the bond. Report production volumes based on one of the following:

Most recent production reports for all engines produced from certified engine families.

Projected sales figures from all certified engine families from the previous model year.

Error: Please select the basis for production volumes.

CBI: Provide estimated total annual U.S.-directed production of Nonroad CI engines:

kW < 19

19 ≤ kW < 56

56 ≤ kW < 130

130 ≤ kW < 225

225 ≤ kW < 450

kW ≥ 450

This is your minimum bond value for 2010.

You must increase the value of your bond if your actual U.S.-directed production volumes for the current calendar year cause this calculated value to increase.

Bond Value Calculation §1054.626 (Small SI)

If you need to post bond under §1054.626, use the following worksheet to calculate the value of the bond.

Report production volumes based on one of the following:

Most recent production reports for all engines produced from certified engine families.

Projected sales figures from all certified engine families from the previous model year.

Error: Please select the basis for production volumes.

CBI: Provide estimated total annual U.S.-directed production of Small SI engines:

Disp. < 225 cc

225 ≤ Disp. < 740 cc

740 ≤ Disp. ≤ 1,000 cc

Disp. > 1,000 cc

This value is your minimum bond value for 2010. Note that the minimum bond value for Small SI engines is $500,000.

You must increase the value of your bond if your actual U.S.-directed production volumes for the current calendar year cause this calculated value to increase.

Worksheet Filer's Name:

Bond and Importation Information

Please detail the following information for all engine families that you will be certifying this year that include any engines that will be imported and introduced into commerce in the United States. Note one family may be on multiple lines because it has multiple importers.

CBI: Enter the total number of engines your company will be importing into the United States this model year.

Error: Please enter the total number of engines your company will be importing.

Engine Manufacturer's) Name, Address or Equipment Manufacturer's) Name (if you are importing equipment), Address

EPA Family Name

Industry

Engine Category

CBI Projected Imports for Next Calendar Year

FOR NON-ROAD COMPRESSION IGNITION ONLY: Number of Units of Past Imports

Paperwork Reduction Act Notice

The public reporting and recordkeeping burden for this collection of information is estimated to average 1.5 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number (2060-0369) in any correspondence. Do not send the completed form to this address.