Energy Supplemental Application 04.19 Page 4 of 5
VI. Offshore & Over Water Exposures:
1. What percentage of Applicant’s work is over water (including marshes, bays, inland waters & offshore)? _______%
2. How often does Applicant or Applicant’s Employees work offshore/overwater? _______per month or _______per annum
3. Does Applicant or Applicant’s Employees stay offshore/overwater? Yes No
If yes, average # of days: ___________ or max # of days: ___________
4. Please describe a typical offshore/over water project including services performed and project duration.
____________________________________________________________________________________________________________
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5. Number of employees offshore at any one time: _________ Professional Staff _________ Labor/Technicians
6. Who is responsible for transportation to offshore worksites? ________________________________________________________
7. What percentage of Applicant’s work is from boats, docks or barges? _______%
8. We do not perform any work or services that require working over water or offshore. Yes No
VII. Operators/Non-Operators: If operations do not pertain to you, please check box. N/A
If completed well schedule is available, please attach and include with submission documents.
1. Is the Applicant:
An operator of record owning working interest in wells, who manages lease operations for his/her
co-owners of the working interest? Yes No
An operator of record not owning working interest in wells, who utilizes a contract operator to manage
lease operations? Yes No
A promoter selling drilling prospects to operators for a carried interest in the wells? Yes No
A lease operator by contract who does not have a working interest in the wells? Yes No
An investor owning a non-operating working interest? Yes No
An operator which has any service contractor subsidiary? Yes No
2. How are drilling/work over operations contracted?
Day Work: ____________________________________________ Footage: ___________________________________
Turnkey: ____________________________________________ Other (attach copy): __________________________
3. How many years in experience? _________________________
4. Indicate the number of producing, saline and shut in wells as a lease operator:
5. Indicate the number of plugged and abandoned wells as a lease operator:
