Wis. Admin. Code Department of Natural Resources NR 667.0151
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 closure costs, as specified in subch. H of ch. NR 667, Wis. Adm. Code. This firm qualifies for the financial test on the basis of having [insert "a current rating for its senior unsecured debt of AAA, AA, A, or BBB as issued by Standard and Poor's or Aaa, Aa, A, or Baa as issued by Moody's Investors Services" or "a ratio of less than 1.50 comparing total liabilities to net worth" or "a ratio of greater than 0.10 comparing the sum of net income plus depreciation, depletion and amortization, minus $10 million, to total liabilities."] 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]. [If this firm qualifies on the basis of its bond rating, fill in the requested information: "This firm has a rating of its senior unsecured debt of" [insert the bond rating] "from" [insert "Standard and Poor's" or "Moody's"]. Complete Line 1. Total Liabilities below and then skip the remaining questions in the next section and resume completing the form at the section entitled Obligations Covered by a Financial Test or Corporate Guarantee.] [If this firm qualifies for the financial test on the basis of its ratio of liabilities to net worth, or sum of income, depreciation, depletion and amortization to net worth, please complete the following section.]
*1. Total Liabilities $______
*2. Net Worth $______
*3. Net Income $______
*4. Depreciation $______
5. Depletion (if applicable) $______
*6. Amortization $______
*7. Sum of Lines 3, 4, 5 & 6 $______
[If the above figures are taken directly from the most recent audited financial statements for this firm insert "The above figures are taken directly from the most recent audited financial statements for this firm." If they are not, insert "The following items are not taken directly from the firms most recent audited financial statements" [insert the numbers of the items and attach an explanation of how they were derived.]
[Complete the following calculations]
8. Line 1 ÷ Line 2 = _______
9. Line 7 ÷ Line 1 = _______
Is Line 8 less than 1.5? ___Yes ___No
Is Line 9 greater than 0.10? ___Yes ___No
[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.]
State | Closure | Long-Term Care | Corrective Action | |
Hazardous Waste Facility Name and ID | ||||
________________________________________ | ______ | $______ | $______ | $______ |
_________________________ |
Hazardous Waste Third Party Liability Municipal Waste Facilities | ||||
_________________________ _________________________ | _____ | $______ | $______ | $______ |
Petroleum Underground Storage Tanks | ||||
_________________________ | _____ | $______ | ||
PCB Storage Facility Name | ||||
_________________________ | _____ | $______ |
Any financial assurance required under, or as part of an action undertaken under, the Comprehensive Environmental Response, Compensation and Liability Act.
Site name
____________________________________________________________
Any other environmental obligations that are assured through a financial test.
Name | Amount | |
___________________ | $______ | |
*10. Total of all amounts | $______ | |
*11. Line 10 + $10,000,000 = | $______ | |
*12. Total Assets | $______ | |
*13. Intangible Assets | $______ | |
*14. Tangible Assets | ||
(Line 12-Line 13) | $______ | |
*15. Tangible Net Worth | ||
(Line 14-Line 1) | $______ | |
*16. Assets in the United States | $______ | |
Is Line 15 greater than Line 11? | ___Yes | ___No |
Is Line 16 no less than Line 10? | ___Yes | ___No |
[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.]
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.]
*1. Total assets $______
*2. Intangible Assets $______
*3.Tangible Assets (Line 1-Line 2) $______
4. Total Liabilities $______
5. Tangible Net Worth (Line 3-Line 4) $______
*6. Assets in the United States $______
7. Amount of liability coverage $______
Is Line 5 At least $10,000,000 greater than Line 7? ___Yes ___No
Is Line 6 at least equal to Line 7? ___Yes ___No
[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.]
Wis. Admin. Code Department of Natural Resources NR 667.0151