Irrevocable Letter of Credit

United States Department of the Interior
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

(Bank Letterhead)
IRREVOCABLE LETTER OF CREDIT

Beneficiary:

Issuing Bank: ________________________
(Name)

United States Office of Surface Mining
Reclamation and Enforcement (OSM)
1999 Broadway, Suite 3320
Denver, Colorado 80202-5733

________________________
(Address)

________________________
(City, State, Zip)

________________________
(Telephone)

Permit Number:
Letter of Credit Number:

Amount: $__________________

Date of Issue:

Date of Expiry: _________________

Ladies/Gentlemen:
On behalf of __________________________, _______________________________
(Permittee/Applicant for L/C)

(Address)

we (Bank) hereby establish an Irrevocable Letter of Credit (LOC) payable in part or full to the
United States Department of the Interior, Office of Surface Mining Reclamation and
Enforcement (OSM), available by draft(s) in an amount not to exceed _______________
_________________________________ ($
), upon receipt of a written
demand by OSM pursuant to 30 CFR §800.50.
This Letter of Credit is effective
(Date)
, (Year) , and will expire at the
close of business on (Date)
, (Year)
. However, this letter of credit will
automatically be extended for periods of
year(s) from any scheduled expiration date (as
originally scheduled or automatically extended) unless ninety (90) days prior to such date we
notify you in writing by certified mail, return receipt requested, that we elect not to renew this
Letter of Credit for such additional period.
Upon receipt of such notice, you may draw on us at sight for the amount of this Letter of
Credit beginning thirty (30) days or less prior to the then-applicable expiration date,
accompanied by a statement signed by the OSM Bond-Approving Officer or his/her designee
certifying that the amount of the drawing represents funds due OSM because the permittee has
failed to replace this Letter of Credit by other suitable bond or letter of credit pursuant to 30 CFR
§800.21(b)(2) and 30 CFR §800.30.
We certify that the amount of the credit herein established will not be reduced for any
reason during the period of this instrument without the written consent of OSM.

Permit No.

L/C No. ____________________

Pursuant to 30 CFR §800.16(e)(1), we will give prompt notice to the permittee and to the
OSM Bond-Approving Officer of any notice received or action filed alleging the insolvency or
bankruptcy of the Bank, or alleging any violations of regulatory requirements which could result
in suspension or revocation of the Bank’s charter or license to do business.
In the event the Bank becomes unable to fulfill our obligations under this Letter of Credit
for any reason, we shall give immediate notice to the permittee and to the OSM Bond-Approving
Officer.
IN WITNESS WHEREOF, the Bank has hereunto set its signature and seal this
day of
,
.
__________________________________________________(Issuing Bank)
(Authorized Officer’s Printed Name and Title)
(Authorized Officer’s Signature)

ACKNOWLEDGEMENT
On this _____ day of _______________________, ______, before me, a Notary Public
in and for the County of _____________________, in the State of ______________________
appeared
to me personally known who, being by me duly sworn, did say that
he/she is ____________________of __________________________ , the Bank named in and
which executed the within instrument, and that the seal affixed to said instrument is the seal of
said Bank, and that said instrument was signed, sealed and delivered on behalf of said Bank by
authority of its Board of Directors, and he/she, as such officer, acknowledged said instrument to
be the free act and deed of said Bank for the uses and purpose of said instrument as therein set
forth.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal on the day,
month and year aforesaid.
My Commission Expires: ___________________ _________________________________
Notary Public in and for said County and State
Paperwork Reduction Act Notice
We use the information required by this form to ensure that the requirements for posting a letter of credit as a collateral bond
under 30 CFR 800.21 have been met. You must provide the requested information to obtain a benefit (a collateral bond that
relies upon an irrevocable letter of credit). Under 30 CFR 842.16, the information collected is a matter of public record.
The time needed to complete this form and submit the requested information will vary depending on individual
circumstances. We estimate that the average time will be 10.5 hours per response. This number includes the time spent
reviewing instructions, learning about the regulations, gathering and maintaining information, and completing and reviewing
the form. If you have comments concerning the accuracy of this estimate or suggestions for simplifying the form or
instructions, you may write to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and
Enforcement, 1849 C Street, NW, Room 4559, Washington, DC 20240..
Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will you be subject
to a penalty for a failure to comply with, a collection of information unless it displays a currently valid OMB control number.
OMB Control No. 1029-0043; expires 10/31/2021

Permit No.

L/C No. ____________________