DEP Oil&Gas Form 5 "Performance Bond for Geophysical Exploration" - Florida

DEP Form Oil&Gas5 or the "Performance Bond For Geophysical Exploration" is a form issued by the Florida Department of Environmental Protection.

Download a fillable PDF version of the DEP Form Oil&Gas5 down below or find it on the Florida Department of Environmental Protection Forms website.

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Download DEP Oil&Gas Form 5 "Performance Bond for Geophysical Exploration" - Florida

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Oil & Gas Form 5
Florida
PERFORMANCE BOND FOR GEOPHYSICAL EXPLORATION
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
This bond (or other form of authorized security) must be submitted to the Department before the related geophysical application will
be processed.
File with the Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400.
(Phone # 850/245-8336) Or, Email: OGP@dep.state.fl.us
Know All Men by These Presents that we, ______________________________________________________________
(Operator, Address, Phone Number, Fax Number)
_________________________________________________________________________________________________
as principal, and ___________________________________________________________________________________
(Surety, Address, Phone Number, Fax Number)
_________________________________________________________________________________________________
as surety, are held hereby and firmly bound unto the Governor of the State of Florida in the penal sum of
_________________________________ lawful money of the United States, for the faithful payment of which we hereby
bind ourselves, our heirs, executors, administrators, and assigns. ($25,000 for each field crew or $100,000 for a blanket
bond covering more than four field crews.)
The condition of this obligation is that the above principal fulfills each and every applicable requirement of Chapter 377,
Part 1, Florida Statutes, and section 62C-26.007, Florida Administrative Code, when conducting geophysical exploration
within the State of Florida, then this obligation shall be void; otherwise, the same shall remain in full force and effect.
Effective date of this bond ____
______________________
(If this is a replacement bond, list all permits to be covered.)
_________________________________________________________________________________________________
Principal
Company:
____ ____________________________________________________________
Agent:
________________________________________________________________
Title:
________________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Surety
Company:
________________________________________________________________
Agent:
________________________________________________________________
Attorney in Fact: _______________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Florida Resident Agent Company:
________________________________________________________________
Agent:
________________________________________________________________
Address/Phone: ________________________________________________________________
Serial Number of Bond: _________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Approved as to Form and Legality:
Approved by Department:
________________________________________
____ _________________________________________
DEP Attorney
Department Approving Authority
________________________________________
_____________________________________________
Date
Title
Date
DEP 51-031(16)
Oil & Gas Form 5
Florida
PERFORMANCE BOND FOR GEOPHYSICAL EXPLORATION
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
This bond (or other form of authorized security) must be submitted to the Department before the related geophysical application will
be processed.
File with the Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400.
(Phone # 850/245-8336) Or, Email: OGP@dep.state.fl.us
Know All Men by These Presents that we, ______________________________________________________________
(Operator, Address, Phone Number, Fax Number)
_________________________________________________________________________________________________
as principal, and ___________________________________________________________________________________
(Surety, Address, Phone Number, Fax Number)
_________________________________________________________________________________________________
as surety, are held hereby and firmly bound unto the Governor of the State of Florida in the penal sum of
_________________________________ lawful money of the United States, for the faithful payment of which we hereby
bind ourselves, our heirs, executors, administrators, and assigns. ($25,000 for each field crew or $100,000 for a blanket
bond covering more than four field crews.)
The condition of this obligation is that the above principal fulfills each and every applicable requirement of Chapter 377,
Part 1, Florida Statutes, and section 62C-26.007, Florida Administrative Code, when conducting geophysical exploration
within the State of Florida, then this obligation shall be void; otherwise, the same shall remain in full force and effect.
Effective date of this bond ____
______________________
(If this is a replacement bond, list all permits to be covered.)
_________________________________________________________________________________________________
Principal
Company:
____ ____________________________________________________________
Agent:
________________________________________________________________
Title:
________________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Surety
Company:
________________________________________________________________
Agent:
________________________________________________________________
Attorney in Fact: _______________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Florida Resident Agent Company:
________________________________________________________________
Agent:
________________________________________________________________
Address/Phone: ________________________________________________________________
Serial Number of Bond: _________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Approved as to Form and Legality:
Approved by Department:
________________________________________
____ _________________________________________
DEP Attorney
Department Approving Authority
________________________________________
_____________________________________________
Date
Title
Date
DEP 51-031(16)
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