Download 06 Module 05 Ownership-Compliance Information

5600-PM-BMP0321-5
3/2012
Module 5: Ownership/Compliance Information
Instructions: Provide the following information on an 8½ x 11” sheet of paper. Attach the page(s) to this module and
identify as Exhibit 5: Ownership/Compliance Information. Use module number, letter and heading to
identify information.
Note: If applicant is currently a licensed mine operator or has submitted an application for mine operators license to
the Department, provide only information requested in Modules 5.2, 5.3, 5.4 and Module 5.5, if applicable. The
ownership information requested in Module 5.1 will be generated from the license information on file with the
Department (in eFACTS). That information will be made part of this Module. Include any information required
below that is not on the license application.
5.1
Ownership and Related Entities
Provide the following ownership and compliance information.
a. Name and address of all owners, partners (both general and limited), officers, managers and directors.
b. Name and address of all principal shareholders/members (Note: A principal shareholder/member is any
person who is legal owner of ten percent or more of any class of voting stock).
c.
Name, address, and employer identification number of all related companies (if applicant has a parent or
subsidiary company).
d. Name and address of all owners, partners (both general and limited), officers, and directors for each
company listed in subsection c).
e. Name and address of all principal shareholders for each company listed in Module 5.1c).
f.
Identify any persons listed in Modules 5.1a and 5.1b who, within the five-year period preceding the date of
this application, owned or controlled a coal mining operation or were involved (as an individual, officer,
partner, director or principal shareholder) in a company that owned or controlled a coal mining operation
and such mining was conducted or the company operated under a different name from that of the permit
applicant (for this application). Also identify name company operated under, employer identification
number, Federal or state mining permit number (and date of issuance) and MSHA permit number (and date
of issuance).
g. Name of persons listed in subsections a) and b) who presently own or control a coal mining operation or
are involved (as an individual, officer, partner, director or principal shareholder) in a company (other than
those companies listed in subsection c) that owns or controls a coal mining operation and such mining is
conducted under or the company operated under a different name from that of the permit applicant (for this
application). Also identify name company operated under, employer identification number, federal or state
mining permit number (and date of issuance) and MSHA permit number (and date of issuance).
h. For each person listed in Module 5.1(a) through 5.1(h), provide the following: employee identification
number, social security number (voluntary), title of person’s position, date position or stock ownership was
assumed, date of departure from position (if applicable), percentage of ownership, location within
organizational structure, relationship to the applicant.
5.2
Other Information
Provide the name and address for the following:
a. Person(s) having the ability to commit the financial or real property assets or working resources of an entity.
b. Person(s) who have another relationship with the permit applicant which gives the person authority directly
or indirectly to determine the manner in which the proposed coal mining activity is to be conducted.
c.
The resident agent of the applicant who will accept service of process.
d. The person who will pay the abandoned mine land reclamation fee.
5.3
Coal Rights
Provide the name, address, social security number (optional) and employer identification number of the person
owning the coal to be mined under the proposed permit under a lease, sublease or other contract, and, if not
the same, the person having the right to receive the coal after mining or having authority to determine the
manner in which the proposed coal mining activity is conducted.
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5600-PM-BMP0321-5
5.4
3/2012
Compliance Information (Federal)
a. Identify all Federal and State (other than Pennsylvania) mining permits in the last five-year period prior to
the date of submission of this application that the applicant or any related party had suspended or revoked,
or forfeited the mining bond or similar security. (Note: A related party is any partner, associate, officer,
director, shareholder, parent corporation, subsidiary corporation, affiliate or persons under common control
with the applicant, contractor or subcontractor.) Provide the following for each mining permit suspension,
revocation, and forfeiture:
i.
Identification number, date of permit issuance, and date and amount of bond or similar security
forfeited;
ii.
Identification of the authority that suspended or revoked the permit, or forfeited the bond, and the stated
reason for that action;
iii. The current status of the permit, bond or similar security involved;
iv. The date, location, and type of administrative or judicial proceedings initiated concerning the
suspension, revocation, or forfeiture including the name of the person to whom the action was issued;
and
v.
The current status of the proceedings identified in Module 5.4(iv).
b. List each violation of the Federal Surface Mining Control and Reclamation Act of 1977, or of State Law or
regulation enacted there under, and any law, rule or regulation of the United States pertaining to air, water
or environmental protection incurred in conjunction with any coal mining activities during the three (3)-year
period prior to the date of application, for which the applicant or a person who owns or controls the
applicant has been found responsible in any adjudicated proceeding, agreement, consent order or decree,
or which resulted in a cease order or an assessment of a civil penalty notice received by the applicant or
person who owns or controls the applicant. For each violation notice, provide the following:
i.
The date of issuance and identity of the appropriate regulatory authority, department, or agency;
ii.
Permit number, compliance order number and a brief description of the particular violation;
iii. The date, location, and type of any administrative or judicial proceedings initiated concerning the
violation;
iv. The current status of the violation; and
v.
5.5
The actions taken by the applicant to abate the violation, and proof which is satisfactory to the
regulatory authority, department, or agency which has jurisdiction over such violation that the violation
has been corrected, or is in the process of being corrected.
Contractor
If a contractor will be conducting this operation, provide the following ownership and compliance information.
a. Name, address, employer identification number and social security number (optional) of the contractor. If
the contractor is a business entity other than a single proprietor, provide the name and address of the
respective principals and officers and include the following information for each person listed:
i.
Title of position.
ii.
Date position or stock ownership was assumed.
iii. Date of departure from position (if applicable).
iv. Percentage title of position.
v.
Location within organizational structure.
b. Provide the compliance information requested in Module 5.4 for federal mining permits and also provide the
equivalent compliance information for mining permits within Pennsylvania.
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