Form MMS-1123 Designation of Operator

U.S. Department of the Interior Bureau of Ocean Energy Management, Regulation and Enforcement

OMB Control Number 1010-0114 OMB Approval Expires xx/xx/xxxx

DESIGNATION OF OPERATOR

The lessee identified below is, on the records of the Bureau of Ocean Energy Management, Regulation and Enforcement, a leaseholder of:

Lease Number:

Regional Office:

and hereby designates

Name: _________________

Company Number of

Designated Operator

Address:

as the operator and local agent (designated operator) with full authority to act in the lessee’s behalf in complying with the terms of the lease and applicable regulations. The Regional Supervisor or his representative may serve the designated operator written or oral instructions in securing compliance with the operating regulations. This designation of operator is made with respect to (describe block or aliquot portion to which this designation applies):

It is understood that this designation of operator does not relieve the lessee of responsibility for compliance with the terms of the lease, laws, and regulations applicable to the area. It is also understood that this designation of operator does not constitute an assignment of any interest in the lease.

In case of default on the part of the designated operator, the lessee will make full and prompt compliance with all regulations, lease terms, or orders of the Secretary of the Interior or his representative.

The lessee agrees to notify the Regional Supervisor promptly of any change in the designated operator. The Designated Operator shall comply with the Department of the Interior’s nonprocurement debarment and suspension regulations as required by Subpart A of 2 CFR Part 180 and by Subpart B of 2 CFR Part 1400 and shall communicate the requirement to comply with these regulations to persons with whom it does business related to this designation by including this term in its contracts and transactions.

___________________ ___________________________________________

Company Number of Lessee Name of Lessee

_______________________ _____________________________________________________

Date Authorized Signature of Lessee

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BOEMRE collects this information to be informed of who is authorized to act on behalf of the lessees to fulfill their obligations under the OCS Lands Act, lease, and applicable regulations, and who is authorized to receive notices and comply with regulatory orders issued. Responses are mandatory (43 U.S.C. 1331 et seq.). No proprietary information is collected. An agency may not conduct or sponsor, and you are 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. You may direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Mail Stop 5438, Bureau of Ocean Energy Management, Regulation and Enforcement, 1849 C Street, NW, Washington, DC 20240.

BOEMRE Form MMS-1123 (Mo/year - Supersedes all previous editions of this form which may not be used.) Page 1 of 1