Date bond executed:
Effective date:
Principal: [legal name and business address of owner or operator]
Type of Organization: [insert “individual,” “joint venture,” “partnership,” or “corporation”]
State of incorporation:
Surety(ies): [name(s) and business address(es)]
EPA Identification Number, name, address and amount(s) for each facility guaranteed by this bond:
Total penal sum of bond: $
Surety’s bond number:
Know All Persons By These Presents, That we, the Principal and Surety(ies) are firmly bound to the Wisconsin Department of Natural Resources in the event that the hazardous secondary material at the reclamation or intermediate facility listed below no longer meet the conditions of the exclusion under s. NR 661.0004 (1) (x), Wis. Adm. Code, in the above penal sum for the payment of which we bind ourselves, our heirs, executors, administrators, successors, and assigns jointly and severally; provided that, where the Surety(ies) are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum “jointly and severally” only for the purpose of allowing a joint action or actions against any or all of us, and for all other purposes each Surety binds itself, jointly and severally with the Principal, for the payment of such sum only as is set forth opposite the name of such Surety, but if no limit of liability is indicated, the limit of liability shall be the full amount of the penal sum. Whereas, said Principal is required, under the Resource Conservation and Recovery Act as amended (RCRA), to have a permit or interim status in order to own or operate each facility identified above, or to meet conditions under s. NR 661.0004 (1) (x), Wis. Adm. Code, and Whereas, said Principal is required to provide financial assurance as a condition of permit or interim status or as a condition of an exclusion under s. NR 661.0004 (1) (x), Wis. Adm. Code, and Whereas, said Principal shall establish a standby trust fund as is required when a surety bond is used to provide such financial assurance;
Now, Therefore, the conditions of the obligation are such that if the Principal shall faithfully, before the beginning of final closure of each facility identified above, fund the standby trust fund in the amount(s) identified above for the facility,
Or, if the Principal shall satisfy all the conditions established for exclusion of hazardous secondary material from coverage as solid waste under s. NR 661.0004 (1) (x), Wis. Adm. Code. Or, if the Principal shall fund the standby trust fund in such amount(s) within 15 days after a final order to begin closure is issued by the department or a U.S. district court or other court of competent jurisdiction,
Or, if the Principal shall provide alternate financial assurance, as specified in subch. H of ch. NR 661, Wis. Adm. Code, as applicable, and obtain the department’s written approval of such assurance, within 90 days after the date notice of cancellation is received by both the Principal and the department from the Surety(ies), then this obligation shall be null and void; otherwise it is to remain in full force and effect. The Surety(ies) shall become liable on this bond obligation only when the Principal has failed to fulfill the conditions described above. Upon notification by the department that the Principal has failed to perform as guaranteed by this bond, the Surety(ies) shall place funds in the amount guaranteed for the facility(ies) into the standby trust fund as directed by the department.
The liability of the Surety(ies) may not be discharged by any payment or succession of payments hereunder, unless and until such payment or payments shall amount in the aggregate to the penal sum of the bond, but in no event shall the obligation of the Surety(ies) hereunder exceed the amount of said penal sum.
The Surety(ies) may cancel the bond by sending notice of cancellation by certified mail to the Principal and to the department, provided, however, that cancellation may not occur during the 120 days beginning on the date of receipt of the notice of cancellation by both the Principal and the department, as evidenced by the return receipts.
The Principal may terminate this bond by sending written notice to the Surety(ies), provided, however, that no such notice shall become effective until the Surety(ies) receive(s) written authorization for termination of the bond by the department.
[The following paragraph is an optional rider that may be included but is not required.]
Principal and Surety(ies) hereby agree to adjust the penal sum of the bond yearly so that it guarantees a new amount, provided that the penal sum does not increase by more than 20 percent in any one year, and no decrease in the penal sum takes place without the written permission of the department.
In Witness Whereof, the Principal and Surety(ies) have executed this Financial Guarantee Bond and have affixed their seals on the date set forth above.
The persons whose signatures appear below hereby certify that they are authorized to execute this surety bond on behalf of the Principal and Surety(ies) and that the wording of this surety bond is identical to the wording specified in s. NR 661.0151 (2), Wis. Adm. Code, as such regulations were constituted on the date this bond was executed. Principal
[Signature(s)]
[Name(s)]
[Title(s)]
[Corporate seal]
Corporate Surety(ies)
[Name and address]
State of incorporation:
Liability limit: $
[Signature(s)]
[Name(s) and title(s)]
[Corporate seal]
[For every co-surety, provide signature(s), corporate seal, and other information in the same manner as for Surety above.]
Bond premium: $
NR 661.0151(3)(3) A letter of credit, as specified in s. NR 661.0143 (3), shall be worded as follows, except that instructions in brackets are to be replaced with the relevant information and the brackets deleted. Irrevocable Standby Letter of Credit
[Address to Wisconsin Department of Natural Resources]
Dear Sir or Madam: We hereby establish our Irrevocable Standby Letter of Credit No.____ in your favor, in the event that the hazardous secondary material at the covered reclamation or intermediary facility(ies) no longer meet the conditions of the exclusion under s. NR 661.0004 (1) (x), Wis. Adm. Code, at the request and for the account of [owner’s or operator’s name and address] up to the aggregate amount of [in words] U.S. dollars $____, available upon presentation of (1) your sight draft, bearing reference to this letter of credit No.__, and
(2) your signed statement reading as follows: “I certify that the amount of the draft is payable pursuant to regulations issued under authority of the Resource Conservation and Recovery Act of 1976 as amended.”
This letter of credit is effective as of [date] and shall expire on [date at least 1 year later], but such expiration date shall be automatically extended for a period of [at least 1 year] on [date] and on each successive expiration date, unless, at least 120 days before the current expiration date, we notify both you and [owner’s or operator’s name] by certified mail that we have decided not to extend this letter of credit beyond the current expiration date. In the event you are so notified, any unused portion of the credit shall be available upon presentation of your sight draft for 120 days after the date of receipt by both you and [owner’s or operator’s name], as shown on the signed return receipts.
Whenever this letter of credit is drawn on under and in compliance with the terms of this credit, we shall duly honor such draft upon presentation to us, and we shall deposit the amount of the draft directly into the standby trust fund of [owner’s or operator’s name] in accordance with your instructions.
We certify that the wording of this letter of credit is identical to the wording specified in s. NR 661.0151 (3), Wis. Adm. Code, as such regulations were constituted on the date shown immediately below. [Signature(s) and title(s) of official(s) of issuing institution] [Date]
This credit is subject to [insert “the most recent edition of the Uniform Customs and Practice for Documentary Credits, published and copyrighted by the International Chamber of Commerce,” or “the Uniform Commercial Code”].
NR 661.0151(4)(4) A certificate of insurance, as specified in s. NR 661.0143 (5), shall be worded as follows, except that instructions in brackets are to be replaced with the relevant information and the brackets deleted: Certificate of Insurance
Name and Address of Insurer (herein called the “Insurer”):
Name and Address of Insured (herein called the “Insured”):
Facilities Covered: [List for each facility: The EPA Identification Number (if any issued), name, address, and the amount of insurance for all facilities covered, which shall total the face amount shown below.]
Face Amount:
Policy Number:
Effective Date:
The Insurer hereby certifies that it has issued to the Insured the policy of insurance identified above to provide financial assurance so that in accordance with applicable regulations all hazardous secondary material can be removed from the facility or any unit at the facility and the facility or any unit at the facility can be decontaminated at the facilities identified above. The Insurer further warrants that such policy conforms in all respects with the requirements of s. NR 661.0143 (4), Wis. Adm. Code, as applicable and as such regulations were constituted on the date shown immediately below. It is agreed that any provision of the policy inconsistent with such regulations is hereby amended to eliminate such inconsistency. Whenever requested by the Wisconsin Department of Natural Resources, the Insurer agrees to furnish to the department a duplicate original of the policy listed above, including all endorsements thereon.
I hereby certify that the wording of this certificate is identical to the wording specified in s. NR 661.0151 (4), Wis. Adm. Code, such regulations were constituted on the date shown immediately below. [Authorized signature for Insurer]
[Name of person signing]
[Title of person signing]
Signature of witness or notary:
[Date]
NR 661.0151(5)(5) A letter from the chief financial officer, as specified in s. NR 661.0143 (5), shall be worded as follows, except that instructions in brackets are to be replaced with the relevant information and the brackets deleted: Letter from Chief Financial Officer
[Address to Wisconsin Department of Natural Resources]
I am the chief financial officer of [name and address of firm]. This letter is in support of this firm’s use of the financial test to demonstrate financial assurance, as specified in subch. H of ch. NR 661, Wis. Adm. Code. [Fill out the following nine paragraphs regarding facilities and associated cost estimates. If your firm has no facilities that belong in a particular paragraph, write “None” in the space indicated. For each facility, include its EPA Identification Number (if any issued), name, address, and current cost estimates.]
1. This firm is the owner or operator of the following facilities for which financial assurance is demonstrated through the financial test specified in subch. H of ch. NR 661, Wis. Adm. Code. The current cost estimates covered by the test are shown for each facility: ____. 2. This firm guarantees, through the guarantee specified in subch. H of ch. NR 661, Wis. Adm. Code, the following facilities owned or operated by the guaranteed party. The current cost estimates so guaranteed are shown for each facility: ____. The firm identified above is [insert one or more: (1) The direct or higher-tier parent corporation of the owner or operator; (2) owned by the same parent corporation as the parent corporation of the owner or operator, and receiving the following value in consideration of this guarantee____, or (3) engaged in the following substantial business relationship with the owner or operator ____, and receiving the following value in consideration of this guarantee____]. [Attach a written description of the business relationship or a copy of the contract establishing such relationship to this letter]. 3. In States where EPA is not administering the financial requirements of subch. H of ch. NR 661, Wis. Adm. Code, this firm, as owner or operator or guarantor, is demonstrating financial assurance for the following facilities through the use of a test equivalent or substantially equivalent to the financial test specified in subch. H of ch. NR 661, Wis. Adm. Code. The current cost estimates covered by such a test are shown for each facility:____. 4. This firm is the owner or operator of the following hazardous secondary material management facilities for which financial assurance is not demonstrated either to EPA or a State through the financial test or any other financial assurance mechanism specified in subch. H of ch. NR 661, Wis. Adm. Code, or equivalent or substantially equivalent State mechanisms. The current cost estimates not covered by such financial assurance are shown for each facility:____. 5. This firm is the owner or operator of the following underground injection control facilities for which financial assurance for plugging and abandonment is required under part 144. The current closure cost estimates as required by 40 CFR 144.62 are shown for each facility:____. 6. This firm is the owner or operator of the following facilities for which financial assurance for closure or post-closure care is demonstrated through the financial test specified in subch. H of ch. NR 664 and subch. H of ch. NR 665, Wis. Adm. Code. The current closure and/or post-closure cost estimates covered by the test are shown for each facility: ____ . 7. This firm guarantees, through the guarantee specified in subch. H of ch. NR 664 and subch. H of ch. NR 665, Wis. Adm. Code, the closure or post-closure care of the following facilities owned or operated by the guaranteed party. The current cost estimates for the closure or post-closure care so guaranteed are shown for each facility: ____. The firm identified above is [insert one or more: (1) The direct or higher-tier parent corporation of the owner or operator; (2) owned by the same parent corporation as the parent corporation of the owner or operator, and receiving the following value in consideration of this guarantee; or (3) engaged in the following substantial business relationship with the owner or operator __, and receiving the following value in consideration of this guarantee __]. [Attach a written description of the business relationship or a copy of the contract establishing such relationship to this letter]. 8. In States where EPA is not administering the financial requirements of subch. H of ch. NR 664 or subch. H of ch. NR 665, Wis. Adm. Code, this firm, as owner or operator or guarantor, is demonstrating financial assurance for the closure or post-closure care of the following facilities through the use of a test equivalent or substantially equivalent to the financial test specified in subch. H of ch. NR 664 and subch. H of ch. NR 665, Wis. Adm. Code,, Wis. Adm. Code. The current closure and/or post-closure cost estimates covered by such a test are shown for each facility: __. 9. This firm is the owner or operator of the following hazardous waste management facilities for which financial assurance for closure or, if a disposal facility, post-closure care, is not demonstrated either to EPA or a State through the financial test or any other financial assurance mechanism specified in subch. H of ch. NR 664 or subch. H of ch. NR 665, Wis. Adm. Code, or equivalent or substantially equivalent State mechanisms. The current closure and/or post-closure cost estimates not covered by such financial assurance are shown for each facility: __. This firm [insert “is required” or “is not required”] to file a Form 10K with the Securities and Exchange Commission (SEC) for the latest fiscal year.
The fiscal year of this firm ends on [month, day]. The figures for the following items marked with an asterisk are derived from this firm’s independently audited, year-end financial statements for the latest completed fiscal year, ended [date].
[Fill in Alternative I if the criteria of sub. (5) (a) 1. of s. NR 661.0143, Wis. Adm. Code, are used. Fill in Alternative II if the criteria of sub. (5) (a) 2. of s. NR 661.0143, Wis. Adm. Code, are used.] ALTERNATIVE I
1. Sum of current cost estimates [total of all cost estimates shown in the nine paragraphs above] $__
*2. Total liabilities [if any portion of the cost estimates is included in total liabilities, you may deduct the amount of that portion from this line and add that amount to lines 3 and 4] $__
*3. Tangible net worth $____
*4. Net worth $____-
*5. Current assets $____
