BOEM-0006 OCS Renewable energy Lease or Grant Designation of Opera

U.S. Department of the Interior Bureau of Ocean Energy Management

OMB Control No.: 1010-0176 Expiration Date: xx/xx/xxxx

OUTER CONTINENTAL SHELF (OCS) RENEWABLE ENERGY LEASE OR GRANT

DESIGNATION OF OPERATOR

The lessee or grantee identified below is, on the records of the Bureau of Ocean Energy Management, a holder of the following lease or grant (check box and enter number):

□ Lease Number: ________ or □ Grant Number: ________

Regional BOEM Office:

and hereby designates:

Name: _________________

Company Number of

Address: Designated Operator

as the operator and local agent (designated operator) with full authority to act on the lessee’s or grantee’s behalf to perform activities to comply with the OCS Lands Act, terms of the lease or grant, and applicable regulations. The designated operator agrees to comply with all terms and conditions of the lease or grant and regulations governing those activities and may be held liable and subject to penalties for its failure to comply during the time it was operator, notwithstanding its subsequent resignation. The Regional Supervisor or his representative may serve the designated operator written or oral instructions in securing compliance with the applicable regulations. This designation of operator is made with respect to the block(s) and/or aliquot part(s) described in Exhibit “A” attached hereto and made a part hereof.

It is understood that this designation of operator does not relieve the lessee or grantee of responsibility for compliance with the terms of the lease, grant, laws, and applicable regulations. It is also understood that this designation of operator does not constitute an assignment of any interest in the lease or grant. In case of default on the part of the designated operator, the lessee or grantee will make full and prompt compliance with all regulations, lease terms, or orders of the Secretary of the Interior or his representative. If there is a change in the designated operator, the lessee or grantee must provide written notice to the Regional Supervisor and identify the new designated operator within 72 hours. The lessee or grantee is the operator and responsible for compliance until BOEM approves designation of the new operator. The designated operator shall comply with the Department of the Interior’s nonprocurement debarment and suspension regulations as required by 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 or Grantee

_______________________ _____________________________________________________

Date Authorized Signatory of Lessee or Grantee

_____________________________________________________

Name and title typed or printed

____________________________________

Authorized Signatory of Designated Operator

__________________________ ____________________________________

Date Name and title typed or printed

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BOEM 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 1 hour 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 HM-3127, Bureau of Ocean Energy Management, 381 Elden Street, Herndon, VA 20170.

Form BOEM-0006 (Mo/Year) Previous Editions are Obsolete PAGE 1 OF 2

EXHIBIT “A”

OUTER CONTINENTAL SHELF (OCS)

RENEWABLE ENERGY LEASE OR GRANT

DESIGNATION OF OPERATOR

□ Lease Number: ________

or

□ Grant Number: ________

The Designation of Operator is made with respect to the following described block(s) and/or aliquot part(s) of the referenced lease or grant:

Area Name or Block Subdivision or Aliquot Part

Protraction Diagram (If entire block, enter “All”)

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

___________________ ________ ________________________

Form BOEM-0006 (Mo/Year) Previous Editions are Obsolete PAGE 2 OF 2