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5Ô_ÔÔ€3ô‹õõôÔòòIdentify€the€respective€roles,€responsibilities,€obligations,€and€accountability€which€each€participant€to€theÐ  Ðagreement€will€assume€in€its€effort€to€achieve€the€stated€joint€objectives.ÌÌList€everything€the€recipient€is€required€to€perform€and€how€the€project€and€performance€will€be€measured€toÏevaluate€the€objectives.ÌÌProvide€the€details€for€the€resources,€such€as€services,€facilities,€equipment,€materials,€supplies,€personnel,€thatÏthe€Agency€and€the€recipient€will€provide,€and€a€schedule€indicating€when€they€will€be€provided.ÌÌYou€may€want€to€add€another€paragraph€("The€*€and€the€Agency€mutually€agree€to:")€for€everything€theÏrecipient€and€Agency€agree€to€do€together.€This€paragraph€may€be€the€first€or€last€paragraph€to€this€section.óó ÍÔ_ÔÔ€3ô‹õõôÔòòFor€cooperative€agreements,€provide€an€explicit€statement€of€the€nature,€character,€and€extent€of€anticipatedÐ  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ÝòòÔ_ÔÔ€3ô‹õõôÔThis€paragraph€is€required€in€all€grants€and€cooperative€agreements.óóTable_A>Q ÿÿ0form[3](1)(a)à0..àà0..àÔ2ÔÔ3  Ôà0..à>d ÿÿ0form[4](1)(a)à0..àà0..àà0..àÔ2ÔÔ3  Ôà0..à>w ÿÿ0form[5](1)(a)à0..àà0..àà0..àà0..àÔ2ÔÔ3  Ôà0..à>Š ÿÿ0form[6](1)(a)à0..àà0..àà0..àà0..àà0..àÔ2ÔÔ3  Ôà0..à> ÿÿ0form[7](1)(a)à0..àà0..àà0..àà0..àà0..àà0..àÔ2ÔÔ3  Ôà0..à>° ÿÿ0form[8](1)(a)à0..àà0..àà0..àà0..àà0..àà0..àà0..àÔ2ÔÔ3  Ôà0..àAP456789 ÿÿ9GOW]emu{form(1)(a)(1)(a)i.(1)(a)(i)1)a)3#37=CIQYag­­1.a.i.(1)(a)(i)1)a);i)Ý ƒz¤T!ÝÓ  ÓÝ  ÝÔ_ÔòòÔ‡X,žXõôÔÔ€3XUŒXXX,žÔñ-ñÖ€HÿÿÖñ-ñà@óó¿ìàóóò òAGREEMENTS€WITH€STATE,€LOCAL,€&€TRIBAL€GOVERNMENTSˆÐ ° Ðà@``ÎìàRural€Fire€Assistanceó óÔ#†3ô‹õX3XUŒ:#ԈРªú Ðà@ËËÐìàÔ_ÔÔ‡3ò‹õõ3ô‹Ôòòñ.ñ12/14/00ñ.ññ.ñ03/01/01ñ.ñÔ_Ô€versionˆÐ ¤ô ÐóóÌThe€following€forms€must€be€completed€by€the€recipient€prior€to€the€initiation€of€the€agreement.€€The€SF€forms€andÏapplicable€OMB€Circulars€may€be€found€on€the€Internet€at€the€following€site:€ÏòòÔ4‚<Ý °ÔÝ‚6ÍOÝÔÿÔòòÝ  ÝÔ5  Ôhttp://www.whitehouse.gov/OMB/grants/index.htmlÔ6¸ÔÝ‚6ÍÕzÝóóÔÿÔÝ  ÝÔ7Ý vúÔóóÐ È  ÐÌà  àÝ‚qk¦ÿÝÝ  ÝÝ‚qk¦±Ýððà0 ` àÝ  ÝSF„424,€€Application€for€Federal€Assistance݃qk¦±ÌÝŒÐZ ª` (#` (# ÐŒÝ  Ýà  àÝ‚qk¦ÿÝÝ  ÝÝ‚qk¦tÝððà0 ` àÝ  ÝSF„424A,€Budget€Information€„€Ô_ÔNonconstructionÔ_Ô€Programs݃qk¦tÝŒÐ# s ` (#` (# ÐŒÝ  Ýà  àÝ‚qk¦ÿÝÝ  ÝÝ‚qk¦bÝððà0 ` àÝ  ÝSF„424B,€Assurances€„€Ô_ÔNonconstructionÔ_Ô€Programs݃qk¦b}ÝŒÐì < ` (#` (# ÐŒÝ  ÝÌThis€form€will€be€completed€by€the€recipient€when€they€execute€the€agreement.Ìà  àÝ‚qk¦ÿÝÝ  ÝÝ‚qk¦—Ýððà0 ` àÝ  ÝDI„2010,€Certification€Regarding€Debarment,€Suspension€and€Other€Responsibility€Matters,€Drug„Ð G—  ÐFree€Workplace€Requirements€and€Lobbying€(This€form€is€located€at€the€end€of€this€model)݃qk¦—²ÝŒÐ ` (#` (# ÐŒÝ  ÝÔ#†3ô‹õõ3ò‹|#ÔÔ‡3ò‹õõ3ô‹Ôà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àÌThis€agreement€shall€only€be€used€in€accordance€with€the€DOI€appropriation€act€of€FY01,€Rural€Fire€Assistance.€€YouÏmay€not€add€subject€items€to€the€project€management€plan,€however,€you€are€not€required€to€use€all€three€of€the€itemsÏlisted.€€The€examples€given€are€not€a€complete€listing€and€other€projects€may€be€developed€as€long€as€they€complyÏwith€ð ðtraining,€equipment€purchase,€and€prevention€activities€on€a€cost€share€basis.ððÔ#†3ô‹õõ3ò‹ #ÔÔ‡3ò‹õõ3ô‹ÔÐ ýM ÐÌA.€€Information€will€need€to€be€filled€in€that€is€specific€to€each€agreement.€€Some€of€the€sections,€such€as€Section€I,€II,Ïand€III,€are€obvious€and€the€others€are€marked€with€a€*.€€The€following€procedures€will€help€you€find€all€the€spacesÏthat€require€a€fill„in€or€a€choice€to€be€made€in€the€text:ÌÌà0  à1.€€Start€with€your€cursor€at€the€òòbeginningóó€of€the€model€agreement€and€hit€the€F2€(Find€and€Replace)€key.€€AtÐ ³ Ðthe€bottom€of€the€screen€you€will€see€the€Find€and€Replace€text€box€appear.Ð (#(# ÐÌà0  à2.€€In€the€Find€box€type€in€the€*€(all€the€spaces€to€be€filled€or€choices€are€marked€with€*).Ð (#(# ÐÌà0  à3.€€With€your€mouse€click€on€Find€Next€and€your€cursor€will€automatically€move€to€the€first€*.€€You€will€needÏto€backspace€(to€erase€the€*)€and€type€in€the€information€for€your€agreement€or€make€the€choice€in€text.Ð (#(# ÐÌà0  à4.€€With€the€mouse€click€on€Find€Next€to€move€to€the€next€*€€and€the€next€*€will€appear.Ð (#(# ÐÌà0  à5.€€Keep€doing€this€until€you€reach€the€end€of€the€document.Ð (#(# ÐÌB.€€Edit€the€Agreement€Number€(****)€in€the€Header.€€Once€you€have€filled€in€the€new€number,€you€will€need€to€exitÏout€of€the€Header€by€clicking€on€File,€Close.€€The€first€page€number€in€"Page€___€of€___"€in€the€Header€will€start€withÏPage€2.€€The€second€page€number€is€created€by€a€code€on€the€last€page€of€the€document€(Target€(Pages)).€€Do€notÏdelete€this€code.€€This€page€number€does€not€automatically€change€as€pages€are€added.€€You€must€generate€theÏdocument€(Control€F9)€in€order€for€it€to€change.€€If€you€do€not€generate€the€document€before€you€print,€WordPerfectÏwill€ask€you€if€you€would€like€to€"generate"€before€you€print,€just€answer€"Yes".€ÌÌÔ€>’â¿ÔC.€€"Comments"€have€been€added€throughout€this€document€with€helpful€information€to€assist€you€in€completing€theÏagreement€easier€and€faster.€€The€comments€are€within€an€oval€in€the€left€margin€and€show€up€in€full€text€only€whenÏyou€use€the€mouse€and€click€on€the€oval.€Click€on€the€oval€on€the€left€of€this€paragraph€now.ÌÌD.€€As€you€go€through€the€document€delete€the€administrative€paragraphs€not€needed.€€Select€one€of€the€paragraphsÏif€similar€paragraphs€are€allowed.€€ÌÌIf€you€have€any€questions,€comments,€or€suggested€changes€please€contact€your€Procurement€Analyst€orÏContracting€Officer.Ð  æ-õ+7 ÐÔ#†3ô‹õõ3ò‹o #ÔÑ„°ÑÑX°ÑÒX°ÒÒX°ÒÝ ƒ~mÇÿÝÓ  ÓÝ  ÝÔ€8$ŠÄ"QÔÔ*…ƒRS ddd Xdd Xdd XX€%X€%…ÔÔ,ä dd ÔÔ,°td ÔÔ,4td ÔÔ,°td ÔÔ,°td ÔÔ+  ÔÐ 7€& „Q €Æ€‚x‚ƒƒ„„……7ÐÓÿ¿ÓÔ‡3,Hu,õ3ô‹ÔÌÌÌForm€1511„1ÌÓÿ¿Ó(February€1989)à@” ” <àÔ#†3ô‹õ,3,Hu(#ÔÔ‡3Ü õ3ô‹ÔUnited€States€Department€of€the€InteriorÔ#†3ô‹õ 3ܬ#ÔÔ‡3,Hu,õ3ô‹ÔˆÐ p= Ðà@ù ù !<àÔ#†3ô‹õ,3,Hu#ÔÔ‡3Ü õ3ô‹ÔBureau€of€Land€ManagementÔ#†3ô‹õ 3Ü€#ԈР í  ÐÌà@ #<àÔ‡3 Í !õ3ô‹ÔASSISTANCE€AGREEMENTÔ#†3ô‹õ !3 Í#ԈР™f  ÐÌÔ‡3,Hu,õ3ô‹ÔNOTE:€€By€signing€this€document,€the€recipient€accepts€this€agreement€and€agrees€to€perform€in€accordance€with€all€the€enclosed€terms,€conditions,€andÐ  \  Ðdocuments€attached€hereto.Ô#†3ô‹õ,3,Huq#ÔÐ ;€v, ٠ „„……;Ðà@øø¤Ø àÔ‡3^€+ _õ3ô‹ÔPAGEÔ#†3ô‹õ _3^€+Å#Ô€€€1€€€Ô‡3^€+ _õ3ô‹ÔOFÔ#†3ô‹õ _3^€+#Ô€€€€€€€€Ô‡3^€+ _õ3ô‹ÔPAGESÔ#†3ô‹õ _3^€+^#ԈРC9&üÉ x Æ v €æ€‚ˆ‚ƒƒ…ƒ…CÐÐ *€vv Fƒ „„……*ÐÔ‡3^€+ _õ3ô‹Ô1.€AGREEMENT€NO.Ô#†3ô‹õ _3^€+#ÔРΛ Ѐ€€€€€Ð C9&d1 ˆ æ vv €æ€‚ˆ‚ƒƒ…ƒ…CÐÐ *€vv -úƒ „„……*ÐÔ‡3^€+ _õ3ô‹Ô2.€TASK€ORDER€NO.€Ô#†3ô‹õ _3^€+í#ÔÐ µ‚ Ѐ€€€€€€Ð C9&K  ˆ 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_õ3ô‹Ô11.€COMPLETION€DATEÔ#†3ô‹õ _3^€+—##Ô€€€€€€€€€€€Ð O€vB&Ó 2 ˆ P vv €^€‚ˆ‚ƒƒ„„……OÐÔ‡3^€+ _õ3ô‹Ô12.€TYPE€OF€RECIPIENT€òò(Check€one)óóÐ $ñ3 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+F$#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔSTATEÐ º‡4 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+Ñ$#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔLOCAL€GOVERNMENTÐ ƒP5 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+:%#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔINDIAN€TRIBAL€GOVERNMENTÐ L6 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+®%#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔEDUCATIONAL€INSTITUTIONÐ â7 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+*&#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔINDIVIDUALÐ Þ«8 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+¥&#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔFOR„PROFIT€ORGANIZATIONÐ §t9 Ѐ€€€€€€€Ô#†3ô‹õ _3^€+'#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔNON„PROFIT€ORGANIZATIONÐ p=: Ѐ€€€€€€€Ô#†3ô‹õ _3^€+Ž'#Ôð&ð€Ô‡3^€+ _õ3ô‹ÔOTHER€(SPECIFY)€Ô#†3ô‹õ _3^€+ (#Ôòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÐ 9€vv*9 ;v „„……9ÐÔ‡3^€+ _õ3ô‹Ô13.€FUNDING€INFORMATIONÐ $ñ< ÐÓ€Ó€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Ô#†3ô‹õ _3^€+Ç(#ÔÔ‡3,Hu,õ3ô‹ÔRecipient€€€€€€€€€€€€€€€€€€€€€€€€€€€AgencyÔ#†3ô‹õ,3,Hur)#ÔÔ‡3^€+ _õ3ô‹ÔÐ º‡= ÐThis€obligation€€€€€€€€€€€€€€€€€€$Ô#†3ô‹õ 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ÐPrevious€obligation€€€€€€€€€€€€$Ô#†3ô‹õ _3^€+È*#Ôòò€€€€€€€€€€€€€€€óó€€€€€Ô‡3^€+ _õ3ô‹Ô$Ô#†3ô‹õ _3^€+Y+#Ôòò€€€€€€€€€€€€€€óóÔ‡3^€+ _õ3ô‹ÔÐ È•A ÐÓ€ÓTotal€obligation€€€€€€€€€€€€€€€€€$Ô#†3ô‹õ _3^€+°+#Ôòò€€€€€€€€€€€€€€€óó€€€€€Ô‡3^€+ _õ3ô‹Ô$Ô#†3ô‹õ _3^€+U,#Ôòò€€€€€€€€€€€€€€óóÔ‡3^€+ _õ3ô‹ÔÐ õÂC ÐÌÌShare€Ratio€€€€€€€€€€€€€€€€€€€€€€Ô#†3ô‹õ _3^€+¬,#Ôòò€€€€€€€€10€€€€%óó€€€€€òò€€€€€90€€€€%óóÐ O€vB&ê·F ˆ ^ vv €æ€‚ˆ‚ƒƒ„„……OÐÔ‡3^€+ _õ3ô‹Ô14.€ACCOUNTING€AND€APPROPRIATION€DATAÔ#†3ô‹õ _3^€+¡-#ÔÐ Š W!G Ѐ€€€€€€€€€€€€€€€€€€€€€€€€€€€Ð O€vB& !í!H ˆ æ v €&€‚ˆ‚ƒƒ„„……OÐÔ‡3^€+ _õ3ô‹Ô15.€PROJECT€TITLE€AND€BRIEF€SUMMARY€OF€THE€PURPOSE€AND€OBJECTIVESÔ#†3ô‹õ _3^€+ˆ.#ÔÐ q">#I ÐÌÌÌÌÐ O€vB&+&ø&N ˆ & v €æ€‚ˆ‚ƒƒ„„……OÐÔ‡3^€+ _õ3ô‹Ô16a.€NAME€AND€TITLE€OF€SIGNER€òò(Type€or€print)óóÔ#†3ô‹õ _3^€+s/#ÔÐ |'I(O Ѐ€€€€€€€€Ð 9€vv*(ß(Pv „„……9ÐÔ‡3^€+ _õ3ô‹Ô17a.€NAME€AND€TITLE€OF€ASSISTANCE€ORDERING€OFFICER€òò(Type€or€print)óóÔ#†3ô‹õ _3^€+?0#ÔÐ |'I(Q Ѐ€€€€€€€€€€€€Ð K€vu:&(ß(R ˆ æ vv €÷€‚ˆ‚„„KÐÓ€ÓÔ‡3^€+ _õ3ô‹Ô16b.€RECIPIENTÐ c)0*S ÐÓ€ÓòòÌ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÐ Ú*§+V Ðà@úú6ÊàÔ#†3ô‹õ _3^€+H1#ÔÔ‡3,Hu,õ3ô‹Ôòò(Authorized€Signature)óóÔ#†3ô‹õ,3,Hu;2#ÔÔ‡3^€+ _õ3ô‹ԈР4€vvu#p+=,Wvu „„4ÐÔ#†3ô‹õ _3^€+™2#ÔÔ‡3,Hu,õ3ô‹Ô16c.€DATE€SIGNEDÔ#†3ô‹õ,3,Hu3#ÔÐ c)0*X Ðà@œœ„œàˆÌÐ 8€vvu'©*v+Zvvu „„……8ÐÓ€ÓÔ‡3^€+ _õ3ô‹Ô17b.€UNITED€STATES€OF€AMERICAÐ c)0*[ ÐÓ€ÓÌBY€òò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÔ#†3ô‹õ _3^€+Õ3#ÔÐ Ú*§+^ Ðà@ÎεfàÔ‡3,Hu,õ3ô‹Ôòò(Signature€of€Assistance€Officer)óóÔ#†3ô‹õ,3,HuÌ4#ÔÔ‡3^€+ _õ3ô‹ԈР7€vvu&p+=,_vvu „„7ÐÔ#†3ô‹õ _3^€+55#ÔÔ‡3,Hu,õ3ô‹Ô17c.€DATE€SIGNEDÔ#†3ô‹õ,3,Hu¯5#ÔÐ c)0*` ÐÐ3)'à)­*a ˆ0 ÷ vvu 3ÐÐ  ,Þ,a ÐÒ°XÒÑX„ÑÒ°XÒÖ€VÿÿÖØØÔ€t’â¿ÔÖ€åV[ÖÔ‡3XUŒXõ3ô‹ÔI.€€€òòStatement€of€Joint€ObjectivesÐ ¿ Ðóóà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àÌÔ€è$â‚Ôà  àA.€€òòPurposeóó.€€This€agreement€is€made€and€entered€into€by€the€Department€of€the€Interior,Ð 5  Ð*[BLM,€BIA,€Ô_ÔNPSÔ_Ô,€Ô_ÔFWSÔ_Ô]€and€the€*€[Tribe,€RFD,€Tribal€Fire€Dept.],€for€the€purpose€of€enhancing€theÏfire€protection€capability€of€rural€fire€districts.ÌÌà  àB.€€òòObjectiveóó.€€To€provide€assistance€in€*€training,€equipment€purchase,€and€preventionÐ ð   Ðactivities€on€a€cost€share€basis.€€To€increase€firefighter€safety,€enhance€the€fire€protection€capabilities€ofÏrural€fire€departments,€and€enhance€protection€in€the€urban„wildland€interface.€€To€increase€theÏcoordination€between€local,€State,€Tribal,€and€Federal€firefighting€resources.€€ÌÌà  àC.€€òòAuthorityóó.€Ð Òÿ ÐÌP.L.€106„291,€Making€Appropriations€for€the€Department€of€Interior€and€Related€Agencies€for€theÏFiscal€Year€ending€September€30,€2001,€and€for€Other€Purposes,€which€states,€in€part,€the€DepartmentÏof€Interior€will€provide€rural€fire€assistance.ÌÌ*€(authority€for€Tribes€to€enter€into€a€cooperative€agreement)€National€Indian€Forest€ResourcesÏManagement€Act€P.L.€101„630,€25€U.S.C.€3101„3120€and€25€U.S.C.€450e„1€in€lieu€of€a€P.L.€93„¼638€contract€under€sections€450f€and€450g€when€mutually€agreed€to€by€the€BUREAU.ÌÔ€êÉâ'Ôà  àÌà  àD.€€òòBenefitsóó.€€€The€public/*tribes€will€benefit€by€having€reduced€fire€loss,€the€development€of€fireÐ –ê Ðprevention€programs,€and€the€reduction€of€occurrence€and€intensity€of€wildland€fires€within€the€urbanÏinterface.ÌÌÔ€î’âðÔII.€€òòDefinitionsóó.Ð ~Â$% ÐÌà  àA.€€Agreement:€This€cooperative€agreement.ÌÌà  àB.€€Assistance€Officer€(AO):€The€*[agency]€Assistance€Officer.€€The€AO€is€the€only€individualÏauthorized€to€obligate€funds,€award,€modify€or€terminate€the€agreement.€€The€AO€is€responsible€forÏmonitoring€the€agreement,€enforcing€the€agreement€provisions,€issuing€timely€performance€and€paymentÏapprovals,€terminating€the€agreement,€and€closing€out€the€agreement.Ìà  àÌà  àB.€€Contracting€Officer€(CO):€The€*[agency]€Contracting€Officer.€€The€CO€is€the€onlyÏindividual€authorized€to€obligate€funds,€award,€modify€or€terminate€the€agreement.€The€CO€isÏresponsible€for€monitoring€the€agreement,€enforcing€the€agreement€provisions,€issuing€timelyÏperformance€and€payment€approvals,€terminating€the€agreement,€and€closing€out€the€agreement.Ô#†3ô‹õX3XUŒÚ6#ÔÔ‡3XUŒXõ3ô‹ÔÐ 6)z01 ÐÌà  àC.€€Assistance€Representative€(AR):€The€*[agency]€Assistance€Representative.€€The€AR€will€beÏdesignated€for€the€purpose€of€administering€the€technical€aspect€of€the€agreement.€€The€AR€isÏauthorized€to€clarify€technical€requirements,€and€to€review€and€approve€work€which€is€clearly€within€theÏscope€of€the€work€specified€in€this€agreement.€€The€AR€is€not€authorized€to€issue€changes€or€in€anyÏother€way€modify€this€agreement.Ô#†3ô‹õX3XUŒ¥A#ÔÔ‡3XUŒXõ3ô‹ÔÐ /V67 ÐÐ  0P78 Ðà  àC.€€Contracting€Officerððs€Representative€(COR):€The€*[agency]€Contracting€OfficerððsÏRepresentative.€€The€COR€will€be€designated€for€the€purpose€of€administering€the€technical€aspect€ofÏthe€agreement.€€The€COR€is€authorized€to€clarify€technical€requirements,€and€to€review€and€approveÏwork€which€is€clearly€within€the€scope€of€the€work€specified€in€this€agreement.€€The€COR€is€notÏauthorized€to€issue€changes€or€in€any€other€way€modify€this€agreement.Ô#†3ô‹õX3XUŒ±C#ÔÔ‡3XUŒXõ3ô‹Ôà È àÐ üè Ðà  àÌà  àD.€*[agency.]€May€also€be€referred€to€as€*Bureau/Service.ÌÌà  àE.€€The€Code€of€Federal€Regulations€(CFR).ÌÌà  àF.€€Fiscal€Year€(FY):€The€Federal€fiscal€year€which€extends€from€October€1€of€one€yearÏthrough€September€30€of€the€following€year.ÌÌà  àG.€€The€*.€€May€also€be€referred€to€as€recipient.Ìà  àÌà  àH.€€NTE:€€Not„to„ExceedÔ#†3ô‹õX3XUŒñE#ÔÔ‡3XUŒXõ3ô‹ÔÐ º¦ ÐÌà  àI.€€The€Office€of€Management€and€Budget€(OMB)Ô#†3ô‹õX3XUŒÞG#ÔÔ‡3XUŒXõ3ô‹Ô.Ð ®š ÐÌà  àJ.€€Project€Inspector€(PI):€The€*[agency]€project€inspector.€€At€the€time€of€award,€a€*[agency]Ïemployee(s)€may€be€appointed€as€the€PI.€€If€appointed,€the€PI€will€be€responsible€for€providing€on„siteÏinspection€of€the€work€and€for€giving€the€*€representative€any€special€instructions,€guidance,€or€trainingÏnecessary€to€complete€or€perform€the€work.€€The€PI€will€not€be€authorized€to€issue€changes€or€in€anyÏway€modify€the€agreement.ÌÌÔ€ö’âðÔà  àK.€€Project€Manager:€The€recipient's€Project€Manager.€€*ÌÌÔ€ø[â¹Ôà  àL.€€Responsible€Official:€The€recipient's€Responsible€Official.€€The€responsible€official€is€theÏindividual€who€is€authorized€to€act€for€the€recipients€organization€and€commit€the€recipient€toÏcompliance€with€the€terms€and€conditions€of€this€agreement.ÌÌÔ€þ£â ÔIII.€òòProject€Management€Planóó.Ð Z#ð.( ÐÌà  àA.€€The€*[recipient]€agrees€to:€€(Examples)Ô#†3ô‹õX3XUŒoH#ÔÔ‡3XUŒXõ3ô‹ÔÐ N%ä0* ÐÌà  àà ` à1.€€Training:€Provide/attend€wildland€fire€suppression€training€(includes€costs€ofÏassociated€travel€in€accordance€with€Federal€Travel€Regulations).€€Assist€in€the€planning€andÏcoordination€of€the€wildland€fire€training€course(s).€€Provide€wildland€fire€training€instructor.€€ProvideÏwildland€fire€training€materials€and€conference€room€facilities.€€ÌÌà  àà ` à2.€€Equipment€purchase:€Purchase€wildland€personal€protective€equipment€forÏfirefighters.€€Purchase€supplies€and€materials€associated€with€wildland€firefighting€activities,€i.e.,€fusees,Ïhose,€adapters,€nozzles,€drip€torches,€etc.€€Purchase€of€wildland€fire€tools,€radios,€engines,€trucks,Ïpumps€and€pump€packages€to€be€identified€by€types€and€quantities.ÌÐ  0¢;5 Ðà  àà ` à3.€€Prevention€activities:€Establish€a€fire€safe€community€protection€program.€€PrepareÏtriage€assessments€for€urban€interface€areas.€€Develop€a€community€prevention€program.€€CooperateÏwith€Planning€and€Zoning€to€develop€standards€for€wildland€urban€interface€areas.ÌÌÔ€¶âÔÌà  àB.€€The€*[agency]€agrees€to:€(Examples)ÌÌà  àà ` à1.€€Training:€Assist€in€identifying€training€opportunities€and€developing€training€plans€forÏrural€firefighters.€€Provide€instructor(s)€for€wildland€training€course(s).€€Provide€wildland€fire€trainingÏmaterials€and€conference€room€facilities.€€Ô#†3ô‹õX3XUŒL#ÔÔ‡3XUŒXõ3ô‹ÔÐ Þ Þ  ÐÌà  àà ` à2.€€Equipment€Purchase:€Purchase€equipment€and/or€facilitate€transfer€within€applicableÏregulations.€€(Hand€receipt€or€transfer)€Types€of€equipment€may€include,€but€is€not€limited€to,€trucks,Ïengines,€pumps,€pump€packages,€tools,€supplies,€materials,€office€equipment,€etc.ÌÌà  àà ` à3.€€Prevention€activities:€Assist€in€establishing€a€fire€safe€community€protection€program,€Ïpreparing€triage€assessments€for€urban€interface€areas,€and€developing€a€community€preventionÏprogram.€€Cooperate€with€Planning€and€Zoning€to€develop€standards€for€wildland€urban€interface€areas.Ô#†3ô‹õX3XUŒoR#ÔÔ‡3XUŒXõ3ô‹ÔÐ ®® ÐÌà  àà ` à4.€€Provide€payments€to€the€*€in€accordance€with€Section€*,€Financial€Support,€andÏSection€*,€Payments,€of€this€agreement€and€applicable€OMB€and€Treasury€Regulations.ÌÌÔ€íâKÔIV.€€òòTerm€of€Agreementóó.€€This€agreement€shall€become€effective€on€the€date€of€signature€of€theÐ Û  Ð*[agency]€*Contracting/Assistance€Officer€and€shall€remain€in€effect€for€the€remainder€of€FY€*,€unlessÏterminated€in€accordance€with€the€provisions€of€43€CFR€Subpart€C,€Section€12.84.€€This€agreementÏmay€be€renewed€for€subsequent€Ô_ÔFYsÔ_Ô€(NTE€a€total€of€five),€subject€to€the€availability€of€Federal€funding,Ïby€mutual€written€modification€signed€by€both€parties€to€this€agreement.ÌÌIV.€€òòTerm€of€Agreementóó.€€This€agreement€shall€become€effective€on€the€date€of€signature€of€theÐ l ·&" Ð*[agency]€*Contracting/Assistance€Officer€and€shall€remain€in€effect€until€*,€unless€terminated€inÏaccordance€with€the€provisions€of€43€CFR,€Subpart€C,€Section€12.84.€€ÌÌV.€€òòFinancial€Supportóó.Ð T$Ÿ*& ÐÌà  àA.€€This€agreement€may€be€funded€each€FY€based€on€the€availability€of€*[agency]€funding.€€TheÏ*€hereby€releases€the€*[agency]€from€all€liability€due€to€failure€of€Congress€to€appropriate€funds.ÌÌà  àB.€€Funds€obligated€but€not€expended€in€one€FY€can€be€carried€forward€and€expended€in€theÏsubsequent€FY.ÌÌà  àC.€€$*€($20,000€ñ*ñannual€ñ*ñcap€set€by€Ô_ÔNatððlÔ_Ô€Fire€Plan€Steering€Group)€represents€the€NTE€amountÏfor€which€the€*[agency]€will€be€responsible€under€the€terms€of€this€agreement.€€The€*[agency]€shall€notÏbe€obligated€to€pay€for€nor€shall€the€*€be€obligated€to€perform€any€effort€that€will€require€theÏexpenditure€of€Federal€funds€above€the€NTE€amount.ÌÐ  0W62 Ðà  àC.€€$*ñ,ññ+ñ*ñ+ññ,ññ+ñ€($20,000€annual€cap€set€by€Ô_ÔNatððlÔ_Ô€Fire€Plan€Steering€Group)Ô#†3ô‹õX3XUŒ*U#ÔÔ‡3XUŒXõ3ô‹Ôñ+ñ€represents€the€annual€€NTEÐ  Ðamount€for€which€the€*[agency]€will€be€responsible€under€the€terms€of€this€agreement.€€EachÏmodification€issued€will€specify€the€NTE€amount€for€that€modification.€€The€*[agency]€shall€not€beÏobligated€to€pay€for€nor€shall€the€*€be€obligated€to€perform€any€effort€that€will€require€the€expenditure€ofÏFederal€funds€above€the€NTE€amount€specified€in€that€modification.ÌÌà  àD.€€Cost€sharing€for€this€agreement€shall€be€in€accordance€with€43€CFR,€Subpart€C,€SectionÏ12.64.€€Other€Federal€fundsÔ#†3ô‹õX3XUŒ7]#ÔÔ‡3XUŒXõ3ô‹Ô€may€not€be€used€for€cost€sharing.€€The€reñ%ññ$ñcñ$ññ%ñquired€cost€share€is€ñ&ñ90%Ð ê Ö Ðñ&ññ'ñ*[ñ'ññ&ñagencyñ&ññ(ñ]ñ(ññ&ñ/10%ñ&ññ)ñ€*[tribe/RFD].€€Cooperatorððs€contribution€may€be€in€the€form€of€in„kind€services.ñ)ñÌÌVI.€òòPaymentsóó.Ð ØÄ  ÐÌÔ€’âðÔà  àA.à ` àElectronic€Funds€Transfer€PaymentsР̨ ÐÌà  àà ` à1.€€Payment€under€this€agreement€will€be€made€by€the€Government€by€electronic€fundsÏtransfer€(through€the€Treasury€Fedline€Payment€System€(FEDLINE)€or€the€Automated€Clearing€HouseÏ(ACH)),€or€National€Institute€of€Health€(NIH)€payment€system.ÌÌà  àà ` à2.€€After€award,€but€no€later€than€14€days€before€an€invoice€or€agreement€financingÏrequest€is€submitted,€the€Recipient€shall€designate€a€financial€institution€for€receipt€of€electronic€fundsÏtransfer€payments€(SF„3881),€and€shall€submit€this€designation€to€the€following€address:ÌÌ*Add€Ô_ÔFWSÔ_Ô,€BIA,€Ô_ÔNPSÔ_Ô€addressesÌÌà  àà ` àà ¸ àBureau€of€Land€ManagementÌà  àà ` àà ¸ àNational€Business€Center,€BC„630Ìà  àà ` àà ¸ àDenver€Federal€Center,€Bldg.€50Ìà  àà ` àà ¸ àPO€Box€25047Ìà  àà ` àà ¸ àDenver,€CO€€80225„0047ÌÌà  àà ` à3.€€If€a€designation€has€been€submitted€to€the€*[agency]€under€a€previous€agreement€it€isÏnot€necessary€to€complete€another€SF„3881€unless€you€are€changing€your€designation€of€financialÏinstitution.ÌÔ€Éâ'Ôà  àÌÔ€[â¹Ôà  àB.€€The€*€shall€be€entitled€to€reimbursement*€or€advance€payment*€at€least€quarterly€uponÏsubmission€of€an€original€Request€for€Advance€or€Reimbursement,€Standard€Form€(SF)€270.€ÏPayments€shall€be€governed€by€the€provisions€of€43€CFR€Subpart€C,€Section€12.61€and€12.81.ÌÌÔ€Éâ'Ôà  àC.€€If€advance€payments€are€made€the€*€must€submit€a€Federal€Cash€Transaction€Report,€SFÏ272€to€the€*Contracting/Assistance€Officer€15€working€days€following€the€end€of€each€quarter.ÌÌà  àD.€€Advance€payments€shall€be€made€only€in€amounts€necessary€to€meet€current€disbursementÏneeds€and€shall€be€scheduled€so€that€the€funds€are€available€only€immediately€prior€to€theirÏdisbursement.Ìà  àà ` àÐ  0ï58 ÐVII.€òòProperty€Management€and€Dispositionóó.Ð  ÐÌÔ€íâKÔà  àAny€*[agency]€property€used€or€other€property€acquired€under€this€agreement,€includingÏintangible€property€such€as€copyrights€and€patents€shall€be€governed€by€the€provisions€of€43€CFR,ÏSubpart€C,€Section€12.71€through€12.74.Ô#†3ô‹õX3XUŒ _#Ô€€€Ô‡3XUŒXõ3ô‹Ô€€Each€party€agrees€that€it€will€be€responsible€for€its€own€actsÐ ü3  Ðand€the€results€thereof€and€shall€not€be€responsible€for€the€acts€of€the€other€party€and€the€results€thereof.€ÏEach€party,€therefore,€agrees,€to€the€extent€authorized€by€applicable€laws€will€assume€all€risks€andÏliability€to€itself,€its€agents€or€employees,€for€any€injury€to€persons€or€property€resulting€from€anyÏoperations€of€its€agents€or€employees€under€this€agreement,€and€for€any€loss,€cost,€damage,€or€expenseÏresulting€at€any€time€from€any€and€all€clauses€due€to€any€acts,€or€negligence,€or€the€failure€to€exerciseÏproper€precautions€of€or€by€itself€or€its€own€agents€to€this€agreement.€€The€*[agency]€assumes€noÏliability€for€any€actions€or€activities€conducted€under€this€agreement€except€to€the€extent€that€recourse€orÏremedies€are€provided€by€Congress€under€the€Federal€Tort€Claims€Act€[28€U.S.C.€1346(b),€2401(b),Ï2671€„€2680,€as€amended€by€P.L.€89„506,€80€Stat.€306.ÌÔ#†3ô‹õX3XUŒ«j#ÔÔ‡3XUŒXõ3ô‹ÔÌÌVIII.€€òòDeliverables€and€Reportsóó.Ð ´ë ÐÌà  àSubmit€one€copy€of€an€annual€performance€report€to€the€*[agency]€within€90€days€after€the€endÏof€the€FY.€€The€performance€report€must€be€prepared€in€accordance€with€43€CFR,€Subpart€C,€SectionÏ12.80€and€address€items€such€as€a€comparison€of€actual€accomplishments€with€established€goals,Ïreasons€why€goals€may€not€have€been€met,€cost€overruns€and€any€other€pertinent€information.ÌÌIX.€€€òòKey€Officialsóó.Ð ŠÁ ÐÌà  àA.€*Contracting€Officer€(CO)/Assistance€Officer€(AO)Ìà  àà ` àAddressÌà  àà ` àTelephone€Number€ÌÌà  àB.€*Contracting€Officerððs€Representative€(COR)/Assistance€Representative€(AR)Ìà  àà ` àAddressÌà  àà ` àTelephone€Number€ÌÌà  àC.€*Project€Inspector€(PI)Ìà  àà ` àAddressÌà  àà ` àTelephone€Number€ÌÔ#†3ô‹õX3XUŒ´n#ÔÔ‡3XUŒXõ3ô‹ÔÌà  àD.€*Responsible€OfficialÌà  àà ` àAddressÌà  àà ` àTelephone€Number€ÌÔ#†3ô‹õX3XUŒ‘r#ÔÔ‡3XUŒXõ3ô‹ÔÌà  àE.€*Project€ManagerÌà  àà ` àAddressÌà  àà ` àTelephone€Number€ÌÔ#†3ô‹õX3XUŒCs#ÔÔ‡3XUŒXõ3ô‹ÔÐ  0C0/ ÐX.€òòSpecial€Terms€and€Conditionsóó.Ð  ÐÌà  àA.€€Order€of€PrecedenceÌÌà  àAny€inconsistency€in€this€agreement€shall€be€resolved€by€giving€precedence€in€the€followingÏorder:€€(a)€Any€national€policy€requirements€and€administrative€management€standards;€(b)€requirementsÏof€the€applicable€OMB€Circulars€and€Treasury€regulations;€(c)€43€CFR€Part€12;€(d)€special€terms€andÏconditions;€and€(e)€all€Agreement€sections,€documents,€exhibits,€and€attachments.Ìà  àÌÔ#†3ô‹õX3XUŒðs#ÔÔ‡3XUŒXõ3ô‹Ôà  àB.€€ModificationsÐ Þ Ê  ÐÌà  àThis€agreement€may€be€modified€by€written€agreement€signed€by€both€the€*[recipient]€and€theÏCO/AO.€€Administrative€changes€(i.e.€name€change)€which€do€not€change€the€project€managementÏplan,€NTE€amount,€etc.€or€otherwise€affect€the€recipient€may€be€signed€unilaterally€by€the€CO/AO.ÌÌÔ€[â¹Ôà  àC.€€Procurement€ProceduresÌà  àÌà  àIt€is€a€national€policy€to€place€a€fair€share€of€purchases€with€minority€business€firms.€€TheÏDepartment€of€the€Interior€is€strongly€committed€to€the€objectives€of€this€policy€and€encourages€allÏrecipients€of€its€grants€and€cooperative€agreements€to€take€affirmative€steps€to€ensure€such€fairness.€ÏPositive€efforts€shall€be€made€by€recipients€to€utilize€small€businesses,€minority„owned€firms,€andÏwomen's€business€enterprises,€whenever€possible.€€Recipients€of€Federal€awards€shall€take€all€of€theÏfollowing€steps€to€further€this€goal:ÌÌà  àà ` à1.€€Ensure€that€small€businesses,€minority„owned€firms,€and€women's€businessÏenterprises€are€used€to€the€fullest€extent€practicable.ÌÌà  àà ` à2.€€Make€information€on€forthcoming€opportunities€available€and€arrange€time€framesÏfor€purchases€and€contracts€to€encourage€and€facilitate€participation€by€small€businesses,€minority„¼owned€firms,€and€women's€business€enterprises.ÌÌà  àà ` à3.€€Consider€in€the€contract€process€whether€firms€competing€for€larger€contracts€intendÏto€subcontract€with€small€businesses,€minority„owned€firms,€and€women's€business€enterprises.ÌÌà  àà ` à4.€€Encourage€contracting€with€consortiums€of€small€businesses,€minority„owned€firmsÏand€women's€business€enterprises€when€a€contract€is€too€large€for€one€of€these€firms€to€handleÏindividually.ÌÌà  àà ` à5.€€Use€the€services€and€assistance,€as€appropriate,€of€such€organizations€as€the€SmallÏBusiness€Development€Agency€in€the€solicitation€and€utilization€of€small€business,€minority„owned€firmsÏand€women's€business€enterprises.ÌÌXI.€€òòGeneral€Provisionsóó.Ð .½,- ÐÌà  àA.€€National€Policy€Requirements€and€Administrative€Management€Standards.€€All€applicableÐ  0±./ Ðnational€policy€requirements€and€administrative€management€standards€as€set€forth€in€the€Office€ofÏManagement€and€Budget,€Financial€Management€Division,€Directory€of€Policy€Requirements€andÏAdministrative€Standards€for€Federal€Aid€Programs€are€incorporated€by€reference.ÌÌà  àB.€€43€CFR€Part€12,€Administrative€and€Audit€Requirements€and€Cost€Principles€for€AssistanceÏPrograms€is€incorporated€by€reference.ÌÔ#†3ô‹õX3XUŒ:v#ÔÔ‡3XUŒXõ3ô‹ÔÌà  àC.€€OMB€Circular€A„87,€Cost€Principles€for€State€and€Local€Governments€is€incorporated€byÏreference.ÌÌà  àD.€€Single€Audit€Act€Amendments€of€1996,€Public€Law€104„156,€110€Stat.€1396,€31€U.S.C.Ï750€1„7€and€43€CFR,€Part€12,€is€incorporated€by€reference.ÌÌà  àE.€€43€Code€of€Federal€Regulations€(CFR)€Part€12,€Appendix€A€to€Subpart€D,€CertificationÏRegarding€Debarment,€Suspension,€and€Other€Responsibility€Matters€„€Primary€Covered€TransactionÏand€completed€Form€DI„2010€are€incorporated€by€reference.ÌÌà  àF.€€43€CFR€Part€12,€Appendix€C€to€Subpart€D,€Certification€Regarding€Drug„Free€WorkplaceÏRequirements,€Alternate€I€(Grantees€other€than€individuals)€and€completed€Form€DI„2010€areÏincorporated€by€reference.ÌÌÔ€9âÝÔà  àG.€€3l€U.S.C.€1352,€Certification€Regarding€Lobbying€and€completed€Form€DI„2010€areÏincorporated€by€reference.ÌÔ#†3ô‹õX3XUŒÜ€#ÔÔ‡3XUŒXõ3ô‹ÔÌà  àH.€€Compliance€With€Buy€American€Act.€€Pursuant€to€Sec.€307€of€the€Department€of€theÏInterior€and€Related€Agencies€Appropriations€Act€of€2000,€Public€Law€106„113,€be€advised€of€theÏfollowing:Ô#†3ô‹õX3XUŒž„#ÔÔ‡3XUŒXõ3ô‹ÔÐ xA  Ðà  àà ` à1.€€None€of€the€funds€made€available€in€this€agreement€may€be€expended€by€a€recipientÏunless€the€recipient€agrees€that€in€expending€the€funds€the€recipient€will€comply€with€sections€2€throughÏ4€of€the€Act€of€March€3,€1933€(41€U.S.C.€10a„10c;€popularly€known€as€the€"Buy€American€Act").ÌÌà  àà ` à2.€€Purchase€of€American„made€equipment€and€products.€€In€the€case€of€any€equipmentÏor€product€that€may€be€authorized€to€be€purchased€with€financial€assistance€provided€using€funds€madeÏavailable€in€this€Act,€it€is€the€sense€of€the€Congress€that€entities€receiving€the€assistance€should,€inÏexpending€the€assistance,€purchase€only€American„made€equipment€and€products.ÌÌà  àà ` à3.€€Recipient€also€agrees€to€follow€the€procedures€in€43€CFR€Part€12,€Subpart€E,ÏSection€12.700€„€Buy€American€Requirements€for€Assistance€Programs.ÌÌÔ€(Éâ'Ôà  àI.€€Opposition€to€Any€Legislation.€€Recipient€shall€not€use€any€part€of€the€Governmentððs€fundsÏfor€any€activity€or€the€publication€or€distribution€of€literature€that€in€any€way€tends€to€promote€publicÏsupport€or€opposition€to€any€legislative€proposal€on€which€Congressional€action€is€not€complete.ÌÌÔ€¤‘âïÔà  àJ.€€Increasing€Seat€Belt€Use€in€the€United€States.€€Recipients€of€grants/cooperative€agreementsÏand/or€sub„awards€are€encouraged€to€adopt€and€enforce€on„the„job€seat€belt€use€policies€andÐ  0ë65 Ðprograms€for€their€employees€when€operating€company„owned,€rented,€or€personally€owned€vehicles.€ÏThese€measures€include,€but€are€not€limited€to,€conducting€education,€awareness,€and€other€appropriateÏprograms€for€their€employees€about€the€importance€of€wearing€seat€belts€and€the€consequences€of€notÏwearing€them.ÌÔ#†3ô‹õX3XUŒ¬…#ÔÔ €, ÔÐ  üè ÐÖ€åôÖÓb€ :AP456789(ÿÿ03;bÓÒH°ÒÒH°ÒÑXÑÑXÑÓ  ÓÑTRXà3Ø'Xà3Ø' Letter3Ø' Letterÿ3Ø'TÑÑ€^)EÑà@ÐÐÉìàò òU.S.€Department€of€the€InteriorˆÐ  Ðó óÌÌòòà@v v ¿ìàóóò òÔ‡3&Õ%õ3ô‹ÔCertifications€Regarding€Debarment,€Suspension€andˆÐ w[ Ðà@| | ÀìàOther€Responsibility€Matters,€Drug„Free€WorkplaceˆÌà@ggÌìàRequirements€and€LobbyingˆÌà@ììØìàó óòòˆÌÌóóÒ(,H$H$(ÒÓ ;ÚÓÔ#†3ô‹õ%3&Õ¡#ÔÔ‡3‘ëÂõ3ô‹ÔPersons€signing€this€form€should€refer€to€the€regulations€referencedÐ ßà Ðbelow€for€complete€instructions:ÌÌCertification€Regarding€Debarment,€Suspension,€and€OtherÏResponsibility€Matters€„€Primary€Covered€Transactions€„€ò òTheÐ Ç «  Ðprospective€primary€participant€further€agrees€by€submitting€thisÏproposal€that€it€will€include€the€clause€titled,€"CertificationÏRegarding€Debarment,€Suspension,€Ineligibility€and€VoluntaryÏExclusion€„€Lower€Tier€Covered€Transaction,"€provided€by€theÏdepartment€or€agency€entering€into€this€covered€transaction,Ïwithout€modification,€in€all€lower€tier€covered€transactions€andÏin€all€solicitations€for€lower€tier€covered€transactions.€€ó óSee€belowÐ F* Ðfor€language€to€be€used€or€use€this€form€for€certification€and€sign.€€(See€ò òÐ ó Ðó óAppendix€A€of€Subpart€D€of€43€CFR€Part€12.)€Ð ؼ ÐCertification€Regarding€Debarment,€Suspension,€Ineligibility€andÏVoluntary€Exclusion€„€Lower€Tier€Covered€Transactions€„€(SeeÏAppendix€B€of€Subpart€D€of€43€CFR€Part€12.)ÌÌCertification€Regarding€Drug„Free€Workplace€Requirements€„ÏAlternate€I.€(Grantees€Other€Than€Individuals)€and€Alternate€II.Ï(Grantees€Who€are€Individuals)€„€(See€Appendix€C€of€Subpart€D€of€43ÏCFR€Part€12)ÌÌSignature€on€this€form€provides€for€compliance€with€certificationÏrequirements€under€43€CFR€Parts€12€and€18.€€The€certifications€shallÏbe€treated€as€a€material€representation€of€fact€upon€which€reliance€willÏbe€placed€when€the€Department€of€the€Interior€determines€to€awardÏthe€covered€transaction,€grant,€cooperative€agreement€or€loan.ÌÔ#†3ô‹õÂ3‘ë÷#ÔÔ‡3&Õ%õ3ô‹ÔÐ G+# ÐÒ(,HVHV(ÒÐ ( # Ðò òÓH‹°œXÓó óÔ#†3ô‹õ%3&Õ‡—#ÔÔ‡3‘ëÂõ3ô‹Ôßi€5•J3#h L'"C!< `€€EHçC!zdt{ ’€Ó" ißÔ#†3ô‹õÂ3‘ë=˜#Ôò òÔ‡3‘ëÂõ3ô‹ÔÐ çË$ ÐÓ  ÓÌòòÓ  ÓÔ#†3ô‹õÂ3‘ëë˜#ÔÔ‡3Ü õ3ô‹Ôó óCHECKòò€€€€óóIF€THIS€CERTIFICATION€IS€FOR€A€PRIMARY€COVERED€TRANSACTION€AND€IS€APPLICABLE.ò òÔ#†3ô‹õ 3Ü^™#ÔÔ‡3‘ëÂõ3ô‹ÔóóÐ ­‘& ÐÓ  ÓÌÓl[HðHl·øP ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=H‹lÓó ó(1)à l àThe€prospective€primary€participant€certifies€to€the€best€of€its€knowledge€and€belief,€that€it€and€its€principals:Ð îÒ( ÐÌÓ~[HðHl%øP ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl·ø—X~Óà l à(a)à0 % àAre€not€presently€debarred,€suspended,€proposed€for€debarment,€declared€ineligible,€or€voluntarily€excluded€by€€any€FederalÐ D(* Ðdepartment€or€agency;Ð %$%$ ÐÌà l à(b)à0 % àHave€not€within€a€three„year€period€preceding€this€proposal€been€convicted€of€or€had€a€civil€judgment€rendered€against€them€forÐ cG- Ðcommission€of€fraud€or€a€criminal€offense€in€connection€with€obtaining,€attempting€€to€obtain,€or€performing€a€public€(Federal,€StateÏor€local)€transaction€or€contract€under€a€public€transaction;€violation€of€Federal€or€State€antitrust€statutes€or€commission€ofÏembezzlement,€theft,€forgery,€€bribery,€falsification€or€destruction€of€records,€making€false€statements,€or€receiving€stolen€property;Ð %$%$ ÐÌÓ{XHðHl%P ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%ø—X{Óà l à(c)à0 % àAre€not€presently€indicted€for€or€otherwise€criminally€or€civilly€charged€by€a€governmental€entity€(Federal,€State€€or€local)€withÐ  ø2 Ðcommission€of€any€of€the€offenses€enumerated€in€paragraph€(1)(b)€of€this€certification;€andÐ %$%$ ÐÌÓ~[HðHl%”P ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%P –X~Óà l à(d)€€à0 % àHave€not€within€a€three„year€period€preceding€this€application/proposal€had€one€or€more€public€transactions€(Federal,€State€or€local)Ð 3" 5 Ðterminated€for€cause€or€default.Ð %$%$ ÐÌ(2)à0 l àWhere€the€prospective€primary€participant€is€unable€to€certify€to€any€of€the€statements€in€this€certification,€such€€prospective€participantÐ R$6"8 Ðshall€attach€an€explanation€to€this€proposal.Ð l$l$ Ðò òÌòŒòÓ  Óßi€5™J3#h L72C!< `€€EHq&C!zdt{ ’€©%Ó" ißÐ q&U$; ÐÔ#†3ô‹õÂ3‘ëš#ÔÌÔ‡3Ü õ3ô‹ÔÓ  ÓòòóŒóó óCHECKòò€€€€óóIF€THIS€CERTIFICATION€IS€FOR€A€LOWER€TIER€COVERED€TRANSACTION€AND€IS€APPLICABLE.ò òóóÔ#†3ô‹õ 3ܬ£#ÔÔ‡3‘ëÂõ3ô‹ÔÐ 7)'= ÐÓ  ÓÌó ó(1)à0 l àThe€prospective€lower€tier€participant€certifies,€by€submission€of€this€proposal,€that€neither€it€nor€its€principals€is€presently€debarred,Ð x*\(? Ðsuspended,€proposed€for€debarment,€declared€ineligible,€or€voluntarily€excluded€from€participation€in€this€transaction€by€any€FederalÏdepartment€or€agency.Ð l$l$ ÐÌ(2)à0 l àWhere€the€prospective€lower€tier€participant€is€unable€to€certify€to€any€of€the€statements€in€this€certification,€such€prospective€participantÐ `-D+C Ðshall€attach€an€explanation€to€this€proposal.ò òÔ#†3ô‹õÂ3‘ëh¤#ÔÐ). ,Dl$l$ ÐÔ‡3‘ëÂõ3ô‹ÔÓ  ÓÓ  ÓÓ-H•HðHl%”P –X-ÓÌà • àÔ#†3ô‹õÂ3‘ë2§#ÔÔ‡3,Hu,õ3ô‹ÔDI„2010Ð /c-F Ðà • àJune€1995Ìà • à(This€form€replaces€DI„1953,€DI„1954,€Ìà • àDI„1955,€DI„1956€and€DI„1963)Ô#†3ô‹õ,3,HuƧ#ÔÔ‡3‘ëÂõ3ô‹ÔÐ  Þ0Â.I ÐÑ^)E Ñâ ^âÑ,ÑÑ,Ñâ ^âÑ  ÑÑ^)E Ñâ ^âÑ,ÑÑ,Ñâ ^âÑ  ÑÔ#†3ô‹õÂ3‘떨#ÔÔ€3Í‘ëÂõ3ô‹ÔÓ-üÓÓ1HðHl%”P –XH•i§1ÓÓ]§ÓÓ  Óßl€5’J6&"h \72 P!< `€€EH,P!±dtˆ É€Êà" lßÐ , ÐòòÓ  ÓÔ‡3˜Ü Â3Í‘ëÔÌó óCHECKòò€€€€óóIF€THIS€CERTIFICATION€IS€FOR€AN€APPLICANT€WHO€IS€NOT€AN€INDIVIDUAL.Ô#†3Í‘ë 3˜ÜNª#ÔóóÐ )ý ÐÓ  ÓÌAlternate€I.€€(Grantees€Other€Than€Individuals)ÌÌA.€€The€grantee€certifies€that€it€will€or€continue€to€provide€a€drug„free€workplace€by:ÌÌà l à(a)à0 % àPublishing€a€statement€notifying€employees€that€the€unlawful€manufacture,€distribution,€dispensing,€possession,€or€use€of€a€controlledÐ ÿÓ Ðsubstance€is€prohibited€in€the€grantee's€workplace€and€specifying€the€actions€that€will€be€taken€against€employees€for€violation€ofÏsuch€prohibition;Ð %$%$ ÐÌà l à(b)à % àEstablishing€an€ongoing€drug„free€awareness€program€to€inform€employees€about„„Ð × «  ÐÓ[HðHl%vP ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%”P –XÓà l àà % à(1)€à0 v àThe€dangers€of€drug€abuse€in€the€workplace;Ð~ R v$v$ Ðà l àà % à(2)€à0 v àThe€grantee's€policy€of€maintaining€a€drug„free€workplace;Ð% ù v$v$ Ðà l àà % à(3)€à0 v àAny€available€drug€counseling,€rehabilitation,€and€employee€assistance€programs;€andÐÌ   v$v$ Ðà l àà % à(4)€à0 v àThe€penalties€that€may€be€imposed€upon€employees€for€drug€abuse€violations€occurring€in€the€workplace;Ðs G v$v$ ÐÓ[HðHl%”P ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%vP –XÓÌà l à(c)à0 % àMaking€it€a€requirement€that€each€employee€to€be€engaged€in€the€performance€of€the€grant€be€given€a€copy€of€the€€statement€requiredÐ Á •  Ðby€paragraph€(a);Ð %$%$ ÐÌà l à(d)€€à0 % àNotifying€the€employee€in€the€statement€required€by€paragraph€(a)€that,€as€a€condition€of€employment€under€the€grant,€the€employeeÐ Ô¨ Ðwill€„„Ð %$%$ ÐÓ[HðHl%vP ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%”P –XÓà l àà % à(1)€à0 v à€Abide€by€the€terms€of€the€statement;€andÐ@v$v$ Ðà l àà % à(2)€€à0 v àNotify€the€employer€in€writing€of€his€or€her€conviction€for€a€violation€of€a€criminal€drug€statute€occurring€in€the€workplace€noÐ ç» Ðlater€than€five€calendar€days€after€such€conviction;Ð v$v$ ÐÓ[HðHl%”P ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%vP –XÓÌà l à(e)€€à0 % àNotifying€the€agency€in€writing,€within€ten€calendar€days€after€receiving€notice€under€subparagraph€(d)(2)€from€an€€€employee€orÐ úÎ Ðotherwise€receiving€actual€notice€of€such€conviction.€€Employers€of€convicted€employees€must€provide€€notice,€including€positionÏtitle,€to€every€grant€officer€on€whose€grant€activity€the€convicted€employee€was€working,€unless€the€Federal€agency€has€designatedÏa€central€point€for€the€receipt€of€such€notices.€€Notice€shall€include€the€€identification€numbers(s)€of€each€affected€grant;Ð %$%$ ÐÌà l à(f)€€à0 % àTaking€one€of€the€following€actions,€within€30€calendar€days€of€receiving€notice€under€subparagraph€(d)(2),€with€respect€to€anyÐ —k  Ðemployee€who€is€so€convicted€„„Ð %$%$ ÐÓ[HðHl%vP ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%”P –XÓà l àà % à(1)€€à0 v àTaking€appropriate€personnel€action€against€such€an€employee,€up€to€and€including€termination,€consistent€with€theÐ ×" Ðrequirements€of€the€Rehabilitation€Act€of€1973,€as€amended;€orÐ v$v$ Ðà l àà % à(2)€€à0 v àRequiring€such€employee€to€participate€satisfactorily€in€a€drug€abuse€assistance€or€rehabilitation€program€approved€for€suchÐ oC$ Ðpurposes€by€a€Federal,€State,€or€local€health,€law€enforcement,€or€other€appropriate€agency;Ð v$v$ ÐÓ[HðHl%”P ¨ X°`¸hÀ!$p&È( +x-Ð/(2€4Ø609ˆ;à=HðHl%vP –XÓÌà l à(g)€€à0 % àMaking€a€good€faith€effort€to€continue€to€maintain€a€drug„free€workplace€through€implementation€of€paragraphs€(a)€(b),€(c),€(d),€(e)Ð ‚V' Ðand€(f).ò òÐG(%$%$ ÐÌó óB.€€The€grantee€may€insert€in€the€space€provided€below€the€site(s€for€the€performance€of€work€done€in€connection€with€the€€specific€€grant:Ð •i* ÐÌPlace€of€Performance€(Street€address,€city,€county,€state,€zip€code)Ì____________________________________________________________________________________________________ÌÌ____________________________________________________________________________________________________ÌÌ____________________________________________________________________________________________________ÌÌCheck___if€there€are€workplaces€on€file€that€are€not€identified€here.Ìßf€5‚2"`x×C! `€EQò%C!±tt[ ɉ*%Ó"Afßâ HIHIH$H$â°â HIHIHIHIâ°â HIHIHIHIâ°â HIHIHIHIâ°â HIHIHIHIâ°â HIHIHIHIâ°â H$H$HIHIâÓ  ÓòòÔ‡3˜Ü Â3Í‘ëÔCHECKòò€€€€óóIF€THIS€CERTIFICATION€IS€FOR€AN€APPLICANT€WHO€IS€AN€INDIVIDUAL.ò òóóòŒòÐ )Ù': ÐóŒóÓ  ÓÌÔ#†3Í‘ë 3˜ÜÀ¿#Ôó óAlternate€II.€€(Grantees€Who€Are€Individuals)Ð  *ô(< ÐÌà l à(a)€€à0 % àThe€grantee€certifies€that,€as€a€condition€of€the€grant,€he€or€she€will€not€engage€in€the€unlawful€manufacture,€distribution,€dispensing,Ð n+B*> Ðpossession,€or€use€of€a€controlled€substance€in€conducting€any€activity€with€the€grant;Ð %$%$ ÐÌà l à(b)€€à0 % àIf€convicted€of€a€criminal€drug€offense€resulting€from€a€violation€occurÔ% €„ Ôring€during€the€conduct€of€any€grant€activity,€he€or€she€willÐ -U,A Ðreport€the€conviction,€in€writing,€within€10€calendar€days€of€the€conviction,€to€the€grant€officer€or€other€designee,€unless€the€FederalÏagency€designates€a€central€point€for€the€receipt€of€such€notices.€€When€notice€is€made€to€such€a€central€point,€it€shall€include€theÏidentification€number(s)€of€each€affected€grant.ò òÐÐ/¤.D%$%$ ÐÓ-HHHðHl%”P –X-Óà H àÔ‡33Hu,Â3Í‘ëÔDI„2010Ð w0K/E Ðà H àJune€1995Ìà H à(This€form€replaces€DI„1953,€DI„1954,€Ìà H àDI„1955,€DI„1956€and€DI„1963)Ô#†3Í‘ëÂ,33HuLÄ#ÔÓ1HðHl%”P –XHHÄ1ÓÐ  Ð1¤0H ÐÓ-üÓßi€5MJ3#h L726!< `€€EH,6!zdtn ’€ÊÆ" ißÐ , ÐÔ‡3Ü Â3Í‘ëÔÌÌòòÓ  Óó óCHECKòò€€€€óóIF€CERTIFICATION€IS€FOR€THE€AWARD€OF€ANY€OF€THE€FOLLOWING€AND€Ð [/ ÐTHE€AMOUNT€EXCEEDS€$100,000:€A€FEDERAL€GRANT€OR€COOPERATIVE€AGREEMENT;€ÌSUBCONTRACT,€OR€SUBGRANT€UNDER€THE€GRANT€OR€COOPERATIVE€AGREEMENT.ÌÌCHECKòò€€€€óóIF€CERTIFICATION€IS€FOR€THE€AWARD€OF€A€FEDERAL€Ð ³‡ ÐLOAN€EXCEEDING€THE€AMOUNT€OF€$150,000,€OR€A€SUBGRANT€OR€ÌSUBCONTRACT€EXCEEDING€$100,000,€UNDER€THE€LOAN.óóÐ ß³  ÐÓ  Óò òÌÔ#†3Í‘ë 3ÜòÅ#ÔÌÌó óThe€undersigned€certifies,€to€the€best€of€his€or€her€knowledge€and€belief,€that:Ð U )  ÐÌ(1)à0 l àNo€Federal€appropriated€funds€have€been€paid€or€will€be€paid,€by€or€on€behalf€of€the€undersigned,€to€any€person€for€influencing€or€attemptingÐ «   Ðto€influence€an€officer€or€employee€of€an€agency,€a€Member€of€Congress,€and€officer€or€employee€of€Congress,€or€an€employee€of€a€MemberÏof€Congress€in€connection€with€the€awarding€of€any€Federal€contract,€the€making€of€any€Federal€grant,€the€making€of€any€Federal€loan,€theÏentering€into€of€any€cooperative€agreement,€and€the€extension,€continuation,€renewal,€amendment,€or€modification€of€any€Federal€contract,Ïgrant,€loan,€or€cooperative€agreement.Ð l$l$ ÐÌ(2)à0 l àIf€any€funds€other€than€Federal€appropriated€funds€have€been€paid€or€will€be€paid€to€any€person€for€influencing€or€attempting€to€influenceÐ %ù Ðan€officer€or€employee€of€any€agency,€a€Member€of€Congress,€an€officer€or€employee€of€Congress,€or€an€employee€of€a€Member€of€CongressÏin€connection€with€this€Federal€contract,€grant,€loan,€or€cooperative€agreement,€the€undersigned€shall€complete€and€submit€Standard€Form„¼LLL,€"Disclosure€Form€to€Report€Lobbying,"€in€accordance€with€its€instructions.Ð l$l$ ÐÌ(3)à0 l àThe€undersigned€shall€require€that€the€language€of€this€certification€be€included€in€the€award€documents€for€all€subawards€at€all€tiers€(includingÐ Öª Ðsubcontracts,€subgrants,€and€contracts€under€grants,€loans,€and€cooperative€agreements)€and€that€all€subrecipients€shall€certify€accordingly.Ð l$l$ ÐÌThis€certification€is€a€material€representation€of€fact€upon€which€reliance€was€placed€when€this€transaction€was€made€or€entered€into.€€SubmissionÏof€this€certification€is€a€prerequisite€for€making€or€entering€into€this€transaction€imposed€by€Section€1352,€title€31,€U.S.€Code.€€Any€person€whoÏfails€to€file€the€required€certification€shall€be€subject€to€a€civil€penalty€of€not€less€than€$10,000€and€not€more€than€$100,000€for€each€such€failure.ÌÌÌÌÌÌAs€the€authorized€certifying€official,€I€hereby€certify€that€the€above€specified€certifications€are€true.ÌÌÌÌòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÐ 5 ) ÐSIGNATURE€OF€AUTHORIZED€CERTIFYING€OFFICIALÌÌÌòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÐ á µ- ÐTYPED€NAME€AND€TITLEÌÌÌòò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€óóÐ #a"1 ÐDATEò òÐ 8$ #2 ÐÌÌòòÌÌÌÌÌÌÌÌÌÌÌÌÌÌóóÔ‡3Ü Â3Í‘ëÔÓ-HHHðHl%”P –X-Óà H àÔ#†3Í‘ë 3ÜÔ#ÔÔ‡3,Hu,Â3Í‘ëÔDI„2010Ð “/g.C Ðà H àJune€1995Ìà H à(This€form€replaces€DI„1953,€DI„1954,€Ìà H àDI„1955,€DI„1956€and€DI„1963)Ô#†3Í‘ëÂ,3,Hu–Ô#ÔÐ  ò0Æ/F Ðó óÔ*«ƒâ2 d dä dd ä °td °4td 4°td °°td °RSH$H$«ÔÔ,Ø dd ÔÔ,¼td ÔÔ,¼td ÔÔ,Xtd ÔÔ,Ètd ÔÔ,td ÔÔ,°td ÔÔ+  ÔÐ 7€& , €¥€‚x‚ƒƒ„„……7ÐÔ‡3Ü Â3Í‘ëÔForm€1511„2Ð ¤x Ð(February€1989)Ô#†3Í‘ë 3Üç×#Ôà@X X àÔ€3Ü Â3Í‘ëÔUnited€States€Department€of€the€InteriorÔ€3,Hu, 3ÜԈР: Ðà@½ ½ àÔ€3Ü ,3,HuÔBureau€of€Land€ManagementÔ€3ô‹õ 3ÜԈРФ ÐÔ€ZHH!½ÔÌà@qqàÔ€3 Í !õ3ô‹ÔAMENDMENT€OF€REQUEST€FORˆÐ å Ðà@;;àAPPLICATION/MODIFICATION€OFˆÌà@ÐÐàASSISTANCE€AGREEMENTÔ€3ô‹õ !3 ÍԈР;€v,å  4…… „„……;Ðà@â✜ àÔ€3^€+ _õ3ô‹ÔPAGEÔ€3ô‹õ _3^€+Ô€€1€€Ô€3^€+ _õ3ô‹ÔOFÔ€3ô‹õ _3^€+Ô€€€€€€€€Ô€3^€+ _õ3ô‹ÔPAGESÔ€3ô‹õ _3^€+ԈРC9&¤x  x ¥ v €æ€‚ˆ‚ƒƒ………CÐÐ *€vv ±… … „„……*ÐÔ€3^€+ _õ3ô‹Ô1.€AMENDMENT/MODIFICATION€NO.Ô€3ô‹õ _3^€+ÔÐ 9   Ѐ€€€€€Ð C9&¸Œ  ˆ æ vv €æ€‚ˆ‚ƒƒ………CÐÐ *€vv U … „„……*ÐÔ€3^€+ _õ3ô‹Ô2.€EFFECTIVE€DATE€Ô€3ô‹õ _3^€+ÔÐ  Ý Ѐ€€€€€Ð C9&ˆ\ ˆ æ vv €æ€‚ˆ‚ƒƒ………CÐÐ *€vv Q%… „„……*ÐÔ€3^€+ _õ3ô‹Ô3.€REQUISITION€NO.Ô€3ô‹õ _3^€+ÔÐ Ù­ Ѐ€€€€€Ð O€vB&X, ˆ æ vv €>€‚ˆ‚ƒƒ„„……OÐÔ€3^€+ _õ3ô‹Ô4.€ISSUED€BYÔ€3ô‹õ _3^€+ÔÐ ©} ÐÌÌÌÐ 9€vv*) ý v „„……9ÐÔ€3^€+ _õ3ô‹Ô5.€ADMINISTERED€BY€òò(If€other€than€Item€4.)óóÔ€3ô‹õ _3^€+ÔÐ ©} ÐÌÌÌÐ S€vB&) ý  ˆ > vv €æ€‚ˆ‚ƒƒ„„……SÐÔ€3^€+ _õ3ô‹Ô6.€NAME€AND€ADDRESS€OF€RECIPIENT€òò(No.,€street,€county,€state,€and€ZIP)óóÔ€3ô‹õ _3^€+ÔÐ z N 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