[Complete the following calculations]
[If you did not answer Yes to either of these two questions, you cannot use the financial test and need not complete this letter. Instead, you shall notify the department for the facility that you intend to establish alternate financial assurance as specified in s. NR 667.0143. The owner or operator shall send this notice by certified mail within 90 days following the close of the owner or operator’s fiscal year for which the year-end financial data show that the owner or operator no longer meets the requirements of this section. The owner or operator shall also provide alternative financial assurance within 120 days after the end of such fiscal year.]
Obligations Covered by a Financial Test or Corporate Guarantee
[On the following lines list all obligations that are covered by a financial test or a corporate guarantee extended by your firm. You may add additional lines and leave blank entries that do not apply to your situation.]
Any financial assurance required under, or as part of an action undertaken under, the Comprehensive Environmental Response, Compensation and Liability Act.
Any other environmental obligations that are assured through a financial test.
[You must be able to answer Yes to both of these questions to use the financial test for this facility.]
I hereby certify that the wording of this letter is identical to the wording specified in s. NR 667.0151 as such rules were constituted on the date shown immediately below. [Signature] _________________________
[Name] ____________________________
[Title] _____________________________
[Date] ____________________________
[After completion, send a signed copy of the form to the department. In addition, send a signed copy to every authority who (1) requires a demonstration through a financial test for each of the other obligations in the letter that are assured through a financial test, or (2) accepts a guarantee for an obligation listed in this letter.]
NR 667.0151(2)(2) The chief financial officer of an owner or operator of a facility with a standardized license who uses a financial test to demonstrate financial assurance only for third party liability for that (or other standardized license) facility or facilities shall complete a letter as specified in s. NR 667.0147 (6). The letter shall be worded as follows, except that instructions in brackets are to be replaced with the relevant information and the brackets deleted: 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 for third party liability, as specified in [insert “subchapter H of 40 CFR part 267” or the citation to the corresponding state regulation]. This firm qualifies for the financial test on the basis of having tangible net worth of at least $10 million more than the amount of liability coverage and assets in the United States of at least the amount of liability coverage. 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]. [Please complete the following section.]
[You must be able to answer Yes to both of these questions to use the financial test for this facility.]
I hereby certify that the wording of this letter is identical to the wording specified in s. NR 667.0151 as such rules were constituted on the date shown immediately below. [Signature] _________________________
[Name] ____________________________
[Title] _____________________________
[Date] _____________________________
[After completion, send a signed copy of the form to the department.]
NR 667.0151 HistoryHistory: CR 16-007: cr. Register July 2017 No. 739, eff. 8-1-17; correction in (2) made under s. 35.17, Stats., Register July 2017 No. 739.