U.S. Department of the Interior OMB Control No.: 1010-0176
Bureau of Ocean Energy Management Expiration Date: xx/xx/xxxx
Bond No.____________________ Bond Amount.___________________ Regional BOEM office:_______________
Bond Type: □ Lease- or Grant-Specific □ Supplemental □ Decommissioning
OUTER CONTINENTAL SHELF (OCS) RENEWABLE ENERGY
LESSEE'S, GRANTEE’S, AND OPERATOR'S 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, Grantee, or Operator for Whom the Bond is Issued. Name of Principal: _________________________________________ Mailing Address: ___________________________________________ ___________________________________________ |
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Schedule A: the lease or grant covered by this bond is the following: (Check one and enter Instrument No.) □ Commercial Lease No. :_________________________________ □ Limited Lease No: _____________________________________ □ Right-of-Way (ROW) Grant No. :__________________________ □ Right-of-Use and Easement (RUE) Grant No. :________________ |
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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 of 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. as amended). An Instrument includes individually or collectively any lease, operating agreement, designation of operator or agent, permit, license, right-of-way, right-of-use and easement or project 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 an Agency of the United States. |
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, grantees, and operators will fulfill all Obligations for the entire lease or grant to the same extent as though the Principal were the sole lessee, grantee, or operator for the lease or grant described in Schedule A with the following limitations and exceptions as for payment obligations: ______________________________ _______________________________________________________________________________(use an attached sheet if needed).
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Form BOEM-0005 (mo/year) PAGE 1 OF 3
Previous Editions are Obsolete.
By signing below, the Surety verifies that the information above is correct and agrees to the following:
receivership, or should the representation of the Principal that it has paid its financial Obligations or performed the other Obligations of the lease or grant in accordance with BOEM specifications be materially false and the BOEM relied upon such representation in canceling the bond.
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_____________________________________ ___________________________________
Name of Surety Name of Principal
_____________________________________ ___________________________________
Signature of Person Executing for Surety Signature of Person Executing for Principal
Form BOEM-0005 (mo/year) PAGE 2 OF 3
Previous Editions are Obsolete.
_____________________________________ ___________________________________
Name and Title Typed or Printed Name and Title Typed or Printed
_____________________________________ _____________________________________
Business Address Business Address
Signed on this ________ day of _______________, 20______, in the State of ____________________, in the
presence of:
Signed on this ________ day of _______________, 20______, in the State of ____________________, in the
presence of:
_____________________________________ Signature of Witness
_____________________________________ Name Typed or Printed
_____________________________________ Street Address
_____________________________________ City, State and ZIP |
_____________________________________ Signature of Witness
_____________________________________ Name Typed or Printed
_____________________________________ Street Address
_____________________________________ City, State and ZIP
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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. When the Surety is a corporation, an authorized corporate officer must sign the bond and attest to it over the corporate seal.
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 hold the surety liable for the obligations and liability of the Principal (lessee, grantee or operator). Responses are mandatory. 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 1 hour 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 HM-3127, Bureau of Ocean Energy Management, 381 Elden Street, Herndon, VA 20170.
Form BOEM-0005 (mo/year) PAGE 3 OF 3
Previous Editions are Obsolete.
File Type | text/rtf |
File Title | Form MMS-2028(January 2001) |
Author | mirabelj |
Last Modified By | Bajusz, Arlene |
File Modified | 2013-01-15 |
File Created | 2012-02-08 |