Section 811. APPENDIX A   Financial Assurance Forms

 

Section 811.ILLUSTRATION I   Letter from Chief Financial Officer

 

LETTER FROM CHIEF FINANCIAL OFFICER

 

Director

Illinois Environmental Protection Agency

C/O Bureau of Land #24

1021 North Grand Avenue East

Post Office Box 19276

Springfield, Illinois 62794-9276

 

 

 

Dear Sir or Madam:

 

I am the chief financial officer of ________________________________________________

 

This letter is in support of this firm's use of the gross revenue test and financial test to demonstrate financial assurance pursuant to 35 Ill. Adm. Code 811.715.

 

Owner or Operator:

 

Name: ______________________________________________________________________

 

Address: ____________________________________________________________________

 

City: _______________________________________________________________________

 

Current cost estimate: $________________________________________________________

 

Owner or Operator:

 

Name: ______________________________________________________________________

 

Address: _____________________________________________________________________

 

City: ________________________________________________________________________

 

Current cost estimate: $__________________________________________________________

 

Please attach a separate page if more space is needed for all facilities.

 

Attached is an Owner's or Operator's Bond without Surety or an Owner's or Operator's Bond with Parent Surety for the current cost estimate for each site.  (Strike inapplicable language.)

 

Gross Revenue Test

 

1.         Gross revenue of the firm $_____________

 

2.         Gross revenue from waste disposal operation $_______________

 

3.         Line 2 divided by line 3_____________________

 

 

Financial Test  Alternative I

 

1.         Sum of current cost estimates (total of all cost estimates shown in 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 $____________________________

 

6.         Current liabilities $________________________

 

7.         Net working capital (line 5 minus line 6) $_________________

 

8.         The sum of net income plus depreciation, depletion, and amortization $_____________________

 

9.         Total assets in U.S.  (required only if less than 90 percent of firm's assets are located in the U.S.)  $____________________________

 

Yes/No

 

10.       Is line 3 at least $10 million?_________________________

 

11.       Is line 3 at least 6 times line 1?_______________________

 

12.       Is line 7 at least 6 times line 1?________________________

 

13.       Are at least 90 percent of firm's assets located in the U.S.? If not, complete line 14._______________________________________________________________

 

14.       Is line 9 at least 6 times line 1? ____________________

 

15.       Is line 2 divided by line 4 less than 2.0?_____________________

 

16.       Is line 8 divided by line 2 greater than 0.1?____________________

 

17.       Is line 5 divided by line 6 greater than 1.5?_______________________

 

Signature__________________________________

 

Typed Name__________________________________

 

Title__________________________________

 

Date__________________________________

 

Financial Test  Alternative II

 

1.         Sum of current cost estimates (total of all cost estimates shown in paragraphs above) $__________________________________

 

2.         Current bond rating of most recent issuance of this firm and name of rating service__________________________________

 

3.         Date of issuance of bond__________________________

 

4.         Date of maturity of bond_______________________________

 

5.         Tangible net worth (if any portion of the closure and post-closure cost estimates is included in "total liabilities" on your firm's financial statements, you may add the amount of that portion to this line) $______________

 

6.         Total assets in U.S.  (required only if less than 90 percent of firm's assets are located in the U.S.) $_________________________

 

Yes/No

 

7.         Is line 5 at least $10 million?______________________________

 

8.         Is line 5 at least 6 times line 1?________________________

 

9.         Are at least 90 percent of firm's assets located in the U.S.? If not complete line 10.  __________________________________

 

10.       Is line 6 at least 6 times line 1?______________________

 

Signature_____________________________________________________________

 

Typed name___________________________________________________________

 

Title________________________

 

Date_______________________

 

(Source:  Amended at 35 Ill. Reg. 10842, effective June 22, 2011)