DEP Oil&Gas Form 5A "Rider to Cover Geophysical Operations" - Florida

DEP Form Oil&Gas5A or the "Rider To Cover Geophysical Operations" is a form issued by the Florida Department of Environmental Protection.

The form was last revised in March 1, 1998 and is available for digital filing. Download an up-to-date fillable DEP Form Oil&Gas5A in PDF-format down below or look it up on the Florida Department of Environmental Protection Forms website.

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Download DEP Oil&Gas Form 5A "Rider to Cover Geophysical Operations" - Florida

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Oil & Gas Form 5A
Florida
RIDER TO COVER GEOPHYSICAL OPERATIONS
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-26.002 and 26.007, F.A.C.
This rider may be used in conjunction with Oil & Gas Form 2A to cover bond requirements for geophysical operations specified in
Section 62C-26.007, Florida Administrative Code. File with Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee,
Florida 32399-2400; 850-245-8336. Email:
OGP@dep.state.fl.us
Bond Number____________________, between the Department of Environmental Protection and __________________
_________________________________________________________________________________________________
(Permittee, Address, Phone Number, Fax Number)
____________________________________________________________________________________as principal, and
_________________________________________________________________________________________________
(Surety, Address, Phone Number, Fax Number)
_________________________________________________________________________________________ as
surety, is hereby amended to add the following condition:
Bond Number _____
_______________
, a blanket bond originally submitted to cover oil & gas wells in
Florida, is hereby amended to cover geophysical field operations conducted pursuant to section 62C-
26.007, Florida Administrative Code. Said bond shall be viable until every requirement of section 62C-
26.007 and Chapter 377, Part I, Florida Statutes, relating to geophysical operations has been met, at
which time this obligation shall be void.
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 51-032(16)
Oil & Gas Form 5A
Florida
RIDER TO COVER GEOPHYSICAL OPERATIONS
Form Title:
Department of
Date Revised:
March, 1998
Environmental Protection
Incorporated by Reference in:
Section 62C-26.002 and 26.007, F.A.C.
This rider may be used in conjunction with Oil & Gas Form 2A to cover bond requirements for geophysical operations specified in
Section 62C-26.007, Florida Administrative Code. File with Oil and Gas Program, 2600 Blair Stone Road, MS 3588, Tallahassee,
Florida 32399-2400; 850-245-8336. Email:
OGP@dep.state.fl.us
Bond Number____________________, between the Department of Environmental Protection and __________________
_________________________________________________________________________________________________
(Permittee, Address, Phone Number, Fax Number)
____________________________________________________________________________________as principal, and
_________________________________________________________________________________________________
(Surety, Address, Phone Number, Fax Number)
_________________________________________________________________________________________ as
surety, is hereby amended to add the following condition:
Bond Number _____
_______________
, a blanket bond originally submitted to cover oil & gas wells in
Florida, is hereby amended to cover geophysical field operations conducted pursuant to section 62C-
26.007, Florida Administrative Code. Said bond shall be viable until every requirement of section 62C-
26.007 and Chapter 377, Part I, Florida Statutes, relating to geophysical operations has been met, at
which time this obligation shall be void.
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 51-032(16)
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