(c) To demonstrate that it meets the financial test under paragraph (b) of this section, the chief financial officer of the local government owner or operator, must sign, within 120 days of the close of each financial reporting year, as defined by the twelve-month period for which financial statements used to support the financial test are prepared, a letter worded exactly as follows, except that the instructions in brackets are to be replaced by the relevant information and the brackets deleted: LETTER FROM CHIEF FINANCIAL OFFICER
I am the chief financial officer of [insert: name and address of the owner or operator]. This letter is in support of the use of the local government financial test to demonstrate financial responsibility for [insert: "taking corrective action" and/or "compensating third parties for bodily injury and property damage"] caused by [insert: "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases"] in the amount of at least [insert: dollar amount] per occurrence and [insert: dollar amount] annual aggregate arising from operating (an) underground storage tank(s).
Underground storage tanks at the following facilities are assured by this financial test [List for each facility: the name and address of the facility where tanks assured by this financial test are located. If separate mechanisms or combinations of mechanisms are being used to assure any of the tanks at this facility, list each tank assured by this financial test by the tank identification number provided in the notification submitted pursuant to R.61-92.280.22.
This owner or operator has not received an adverse opinion, or a disclaimer of opinion from an independent auditor on its financial statements for the latest completed fiscal year. Any outstanding issues of general obligation or revenue bonds, if rated, have a Moody's rating of Aaa, Aa, A, or Baa or a Standard & Poor's rating of AAA, AA, A, or BBB; if rated by both firms, the bonds have a Moody's rating of Aaa, Aa, A, or Baa and a Standard and Poor's rating of AAA, AA, A, or BBB.
WORKSHEET FOR MUNICIPAL FINANCIAL TEST
Part I: Basic Information
1. Total Revenues a. Revenues (dollars) _______________ Value of revenues excludes liquidation of investments and issuance of debt. Value includes all general fund operating and non-operating revenues, as well as all revenues from all other governmental funds including enterprise, debt service, capital projects, and special revenues, but excluding revenues to funds held in a trust or agency capacity.
b. Subtract interfund transfers (dollars)c. Total Revenues (dollars)2. Total Expendituresa. Expenditures (dollars) ______________ Value consists of the sum of general fund operating and non-operating expenditures including interest payments on debt, payments for retirement of debt principal, and total expenditures from all other governmental funds including enterprise, debt service, capital projects, and special revenues.
b. Subtract interfund transfers (dollars) ____________c. Total Expenditures (dollars) _______________3. Local Revenues a. Total Revenues (from 1c) (dollars) _______________b. Subtract total intergovernmental transfers (dollars) __________________________c. Local Revenues (dollars) _____________4. Debt Service a. Interest and fiscal charges (dollars) _____________________________________b. Add debt retirement (dollars) _____________________________________c. Total Debt Service (dollars) _____________________________________5. Total Funds (dollars) _________________ (Sum of amounts held as cash and investment securities from all funds, excluding amounts held for employee retirement funds, agency funds, and trust funds)
6. Population (Persons) Part II: Application of Test7. Total Revenues to Population a. Total Revenues (from 1c) _____________________________________b. Population (from 6) _____________________________________c. Divide 7a by 7b _____________________________________d. Subtract 417 _____________________________________e. Divide by 5,212 _____________________________________f. Multiply by 4.095 _____________________________________8. Total Expenses to Population a. Total Expenses (from 2c) _____________________________________b. Population (from 6) _____________________________________c. Divide 8a by 8b _____________________________________d. Subtract 524 _____________________________________e. Divide by 5,401 _____________________________________f. Multiply by 4.095 _____________________________________9. Local Revenues to Total Revenues a. Local Revenues (from 3c) _____________________________________b. Total Revenues (from 1c) _____________________________________c. Divide 9a by 9b _____________________________________d. Subtract .695 _____________________________________e. Divide by .205 _____________________________________f. Multiply by 2.840 _____________________________________10. Debt Service to Population a. Debt Service (from 4c) _____________________________________b. Population (from 6) _____________________________________c. Divide 10a by 10b _____________________________________d. Subtract 51 _____________________________________e. Divide by 1,038 _____________________________________f. Multiply by -1.866 _____________________________________11. Debt Service to Total Revenues a. Debt Service (from 4c) _____________________________________b. Total Revenues (from 1c) _____________________________________c. Divide 11a by 11b _____________________________________d. Subtract .068 _____________________________________e. Divide by .259 _____________________________________f. Multiply by -3.533 _____________________________________12. Total Revenues to Total Expenses a. Total Revenues (from 1c) _____________________________________b. Total Expenses (from 2c) _____________________________________c. Divide 12a by 12b _____________________________________d. Subtract .910 _____________________________________e. Divide by .899 _____________________________________f. Multiply by 3.458 _____________________________________13. Funds Balance to Total Revenues a. Total Funds (from 5) _____________________________________b. Total Revenues (from 1c) _____________________________________c. Divide 13a by 13b _____________________________________d. Subtract .891 _____________________________________e. Divide by 9.156 _____________________________________f. Multiply by 3.270 _____________________________________14. Funds Balance to Total Expenses a. Total Funds (from 5) _____________________________________b. Total Expenses (from 2c) _____________________________________c. Divide 14a by 14b _____________________________________d. Subtract .866 _____________________________________e. Divide by 6.409 _____________________________________f. Multiply by 3.270 _____________________________________15. Total Funds to Population a. Total Funds (from 5) _____________________________________b. Population (from 6) _____________________________________c. Divide 15a by 15b _____________________________________d. Subtract 270 _____________________________________e. Divide by 4,548 _____________________________________f. Multiply by 1.866 _____________________________________16. Add 7f + 8f + 9f + 10f + 11f + 12f + 13f + 14f + 15f + 4.937 __________________________ I hereby certify that the financial index shown on line 16 of the worksheet is greater than zero and that the wording of this letter is identical to the wording specified in R.61-92.280.105(c) as such regulations were constituted on the date shown immediately below.
[Date] ________________________________________
[Signature] ____________________________________
[Name] _______________________________________
[Title] ________________________________________