U.S. Department of the Interior
Bureau of Ocean Energy Management
DESIGNATION OF OPERATOR
The person identified below is, on the records of the Bureau of Ocean Energy Management, a lessee and/or operating rights
owner of:
Page 1 of 1
Previous Editions are Obsolete.
OMB Control No:
1010-0114
Expiration Date: 02/28/2023
__________________________
Qualification Number
of Designated Operator
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BOEM collect t
his information to be informed
of who is authorized to act on behalf of the lessees/operating rights owners to fulfill their obligations under the OCS Lands Act, lease, and applicable
regulations, and who is authorized to receive notices and comply with regulatory orders issued. Responses are mandatory (43 U.S.C. 1331 et seq.). No proprietary
information is collected. An agency may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid
OMB Control Number. Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering
and maintaining data, and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of this form to the
Information Collection Clearance Officer, Bureau of Ocean Energy Management, 45600 Woodland Rd, Sterling, VA 20166.
Form BOEM-1123 (February 2020)
Lease Number: ______________
Regional Office: ___________________________
Check here if description continued on attached sheet.
It is understood that this designation of operator does not relieve the lessee/operating rights owner of responsibility for
compliance with the terms of the lease, laws, and applicable regulations. It is also understood that this designation of
operator does not constitute an assignment of any interest in the lease.
In case of default on the part of the
designated operator,
the
lessee/operating rights
owner
will
make
full
and
prompt complia
nce
with all laws,
regulations, lease terms,
or orders of
the
Secretary
of
the
Interior
or
his/her
representative.
If
BOEM determines the
operator’s performance being conducted on the leased area
described above is
unacceptable, BOEM may disqualify the operator,
or may disapprove or revoke your designation of operator. The operator will be given adequate notice and opportunity for a review
by BOEM Regional officials before initiating or imposing a disqualification. The BOEM Regional Director may require the lessee/
operating rights owner to designate an agent empowered to fulfill the lessee’s/operating rights owner’s obligations under the OCS
Lands Act, the lease, or governing regulations.
The lessee/operating rights owner agrees to notify the Regional Supervisor promptly of any change in the designated operator.
The designated operator shall comply with the Department of the Interior’s nonprocurement debarment and suspension
regulations as required by Subpart A of 2 CFR Part 180 and by Subpart B of 2 CFR Part 1400 and shall communicate the
requirement to comply with these regulations to persons with whom it does business related to this designation by including this
term in its contracts and transactions.
___________________________________________________
Name of Designated Operator
___________________________________________________
Qualification Number of Operator
________________________________________________________
Authorized Signature of Operator
Signatory Name: _____________________________________
Signatory Title: ____________________________________________
Date: ______________________________________________
_
___________________________________________________
Name of Lessee/Operating Rights Owner
___________________________________________________
Qualification Number of Lessee/Operating Rights Owner
_________________________________________________________
Authorized Signature of Lessee/Operating Rights Owner
Signatory Name: _____________________________________
Signatory Title: ____________________________________________
Date: ______________________________________________
and hereby designates
Name of Operator: ___________________________________________________________________
Address: ___________________________________________________________________________
as the designated operator and agent with full authority to act on the lessee’s/operating rights owner’s behalf, to fulfill the lessee’s/
operating rights owner’s obligations under the OCS Lands Act, in compliance with the terms and conditions of the lease, laws and
applicable regulations. The BOEM Regional Supervisor or the authorized BOEM Regional Officer may provide the designated
operator written or oral instructions in securing compliance with the lease, laws, and applicable regulations. This designation of
operator is made with respect to (describe block or aliquot portion of the lease’s area and depth, if appropriate, to which this
designation applies):
