DEP Oil&Gas Form 2A "Performance Bond for Multiple Wells" - Florida

What Is DEP Oil&Gas Form 2A?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 1998;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEP Oil&Gas Form 2A by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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Download DEP Oil&Gas Form 2A "Performance Bond for Multiple Wells" - Florida

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Oil & Gas Form 2A
Florida
PERFORMANCE BOND FOR MULTIPLE WELLS
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-25.08, F.A.C.
This form may be used to affect bond coverage for single or multiple wells and, in conjunction with Form 5A, those geophysical
operations defined in Section 62C-26.007, Florida Administrative Code. In either case, this bond (or other form of authorized security)
must be approved by the Department before the related applications will be processed.
File with the Florida Department of
Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone
850/245-8336). Email:
OGP@dep.state.fl.us
Know All Men by These Presents That We, ________________________________________________________________________
(Operator’s Name and Address)
___________________________________________________________________________________________________________
Phone Number: _
_____________________________________________
Fax Number: _ ___________________________________
as Principal, and ____________________________________________________________________________________________
(Surety’s Name and 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.
The condition of this obligation is that the above principal properly plug the ten or fewer existing and future wells named below (strike
one if appropriate) in Florida for which the principal is or will be (strike one if appropriate) responsible, and otherwise complies with
Chapter 377, Part 1, Florida Statutes, Chapter 62C-29, Florida Administrative Code, and with all Special Permit Conditions of the
Department. The permit numbers of the ten well to be covered are _____________________________________________________
___________________________________________________________________________________________________________
When the above principal plugs said wells and restores said sites or when geophysical rider Form 5A is attached, restores lands
traversed during geophysical operations defined in Section 62C-26.007, Florida Administrative Code, in compliance with the foregoing
Laws, Rules and Regulations, and Special Permit Conditions of the Department, this obligation is void; otherwise, the same shall
remain in full force and effect.
Effective date of this bond: ________________________________. (The ten wells to be covered by this bond and whose permit
numbers appear above must be included by name, location and permit number, and listed on the back of this form or on an attached
page. Future wells, up to a total of ten wells, may be added to this bond at a future date, by reference.)
Principal
Company:
________________________________________________________________
Agent:
________________________________________________________________
Title:
________________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Surety
Company:
________________________________________________________________
Agent:
________________________________________________________________
Attorney in Fact: _______________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
DEP 51-0021(16)
Oil & Gas Form 2A
Florida
PERFORMANCE BOND FOR MULTIPLE WELLS
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-25.08, F.A.C.
This form may be used to affect bond coverage for single or multiple wells and, in conjunction with Form 5A, those geophysical
operations defined in Section 62C-26.007, Florida Administrative Code. In either case, this bond (or other form of authorized security)
must be approved by the Department before the related applications will be processed.
File with the Florida Department of
Environmental Protection, Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee, Florida 32399-2400 (phone
850/245-8336). Email:
OGP@dep.state.fl.us
Know All Men by These Presents That We, ________________________________________________________________________
(Operator’s Name and Address)
___________________________________________________________________________________________________________
Phone Number: _
_____________________________________________
Fax Number: _ ___________________________________
as Principal, and ____________________________________________________________________________________________
(Surety’s Name and 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.
The condition of this obligation is that the above principal properly plug the ten or fewer existing and future wells named below (strike
one if appropriate) in Florida for which the principal is or will be (strike one if appropriate) responsible, and otherwise complies with
Chapter 377, Part 1, Florida Statutes, Chapter 62C-29, Florida Administrative Code, and with all Special Permit Conditions of the
Department. The permit numbers of the ten well to be covered are _____________________________________________________
___________________________________________________________________________________________________________
When the above principal plugs said wells and restores said sites or when geophysical rider Form 5A is attached, restores lands
traversed during geophysical operations defined in Section 62C-26.007, Florida Administrative Code, in compliance with the foregoing
Laws, Rules and Regulations, and Special Permit Conditions of the Department, this obligation is void; otherwise, the same shall
remain in full force and effect.
Effective date of this bond: ________________________________. (The ten wells to be covered by this bond and whose permit
numbers appear above must be included by name, location and permit number, and listed on the back of this form or on an attached
page. Future wells, up to a total of ten wells, may be added to this bond at a future date, by reference.)
Principal
Company:
________________________________________________________________
Agent:
________________________________________________________________
Title:
________________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Surety
Company:
________________________________________________________________
Agent:
________________________________________________________________
Attorney in Fact: _______________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
DEP 51-0021(16)
Florida Resident Agent
Company:
________________________________________________________________
Agent:
________________________________________________________________
Address/Phone/Fax: _____________________________________________________________
Serial Number of Bond: __________________________________________________________
Signature:
________________________________________________________________
Date:
________________________________________________________________
Approved as to Form and Legality:
Approved by Department:
__________________________________________
__________________________________________________
DEP Attorney
Department Approving Authority
__________________________________________
__________________________________________________
Date
Title
Date
DEP 51-0021(16)
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