35 Ill. Adm. Code 807.APPENDIX A
A Financial Assurance Forms
Section 807.APPENDIX A
Financial Assurance Forms
Section 807.ILLUSTRATION I Letter
From Chief Financial Officer
LETTER
FROM CHIEF FINANCIAL OFFICER
Director
Illinois Environmental
Protection Agency
2200 Churchill Road
Springfield, Illinois 62706
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 807.666.
This letter is to demonstrate
financial assurance for the following sites:
Operator:
Name:
Address:
City:
Current cost estimate:
$
Operator:
Name:
Address:
City:
Current cost estimate:
$
Please attach a separate page
if more space is needed for all facilities.
Attached is an Operator's Bond without Surety or an
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 operations $
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% 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% 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% 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% 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