Bid Form For Areawide Oil & Gas Lease Sale - Alaska Department Of Natural Resources

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STATE OF ALASKA

DEPARTMENT OF NATURAL RESOURCES

DIVISION OF OIL AND GAS

BID FORM FOR AREAWIDE OIL & GAS LEASE SALE

Competitive Areawide Oil & Gas

Lease Sale

Parcel

Lease Sale Name

Tract (LST)

(North Slope Only)

Each bidder listed below must be pre-qualified in order to bid. All lease-interest percentages must be expressed in

percentages with the fractional interest carried out to no more than five decimal places. The sum of the lease-interests covered

by this bid must equal 100.00000 percent without rounding.

% Lease

Qualification

Individual Bidder or Bidder Agent

Bidder

Interest

File No.

Bidder Name

Authorized Signature

Date

No. 1

Agent Name and Title (type or print):

No. 2

Agent Name and Title (type or print):

No. 3

Agent Name and Title (type or print):

No. 4

Agent Name and Title (type or print):

Estimated acreage for lease sale tracts are listed in Attachment A of the Sale Announcement and Instructions to Bidders.

Estimated Acreage

Total Bid Per Acre

Total Estimated Bonus Bid

Acres

/Acre

The total bid per acre is controlling in case of discrepancy.

Enclosed is a bid deposit in the sum of $_____________________, which is equal to or greater than the Minimum Bid Deposit, or

20% or more of the Total Estimated Bonus Bid as required by the Sale Announcement and Instructions to Bidders.

I/We certify by signing this form that 1) this bid discloses the percentage interest of each person or entity who has any working interest

in this bid or in any lease issued in response to it and 2) if awarded a lease pursuant to this bid, all successful bidders who have a

working interest in the lease at the time of the lease award notice will execute all copies of the lease form specified in the Sale

Announcement and Instructions to Bidders and comply with all other requirements of the award notice, including the posting of any

required bond, or shall forfeit the entire amount deposited with this bid.

The person responsible for receiving correspondence regarding this bid, as the agent authorized to receive notices on behalf of all

bidders in connection with this bid, is:

Name

Title

Physical Address*

Mailing Address

Telephone Number(s)

Email Address

Instructions for return of bid deposit, if unsuccessful:

* Physical address must be a location acceptable to private delivery or courier services

AS 38.05.035(a) authorizes the director to decide what information is needed to process an application for the sale or use of state land and resources. This

information is made a part of the state public land records and becomes public information under AS 40.25.110 and AS 40.25.120 (unless the information qualifies

for confidentiality under AS 38.05.035(a)(9) and confidentiality is requested). Public information is open to inspection by you or any member of the public. A person

who is the subject of the information may challenge its accuracy or completeness under AS 44.99.310, by giving a written description of the challenged

information, the changes needed to correct it, and a name and address where the person can be reached. False statements made in an application for a benefit

are punishable under AS 11.56.210.

BID FORM FOR AREAWIDE OIL & GAS LEASE SALE

Revised 3/2015