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'/# /c / %0 0 0Level 1Level 2Level 3Level 4Level 5((3m$ zT!   >+ 0form[1](1)(a)23  0..&p d PdDDDD)!dxdx&p Pd dFGFG)!dxdx3+0 d d d3+0 d d dvvG"Thin Top/Bottom! dxdx((3m$ zT!    @ ~m&   _3:Thisiswhatacommentwilllooklike.Togobacktoyourdocumentorgetridofthiscommentjustclickyour  mouseandthiscommentboxwilldisappear.Commentsdonotshowupwhenyouprintyourdocument. f @m"   _ N:NN:$XX$PARTE:0  CertificationRegardingLobbyingn n  0  CertificationforContracts,Grants,Loans,andCooperativeAgreements #N:NY#&d9 Z(Times New Roman vvG"Thin Right/Left!dxdx>> 0form[2](1)(a)0..23  0` ..` TTable_A ~m&   _3:ThisparagraphisrequiredinallgrantsandcooperativeagreementswithallrecipientslistedinOMBCircular  A110.Level 1Level 2Level 3Level 4Level 5 {m'   _3:(#**A00**** X NN(#Page  3  ڀof Pages11  ՀPages  5 ' pdandrea0pdandrea .   vvvv)!dxdx_  ,  ,  % ~m&   _3:ThisformispreparedbytheAssistanceOfficer.Itisusedasthecoverpageoftheagreement.Usethearrowkeystonavigatein  theformandmakesureyouneverexceedthenumberofcharactersforaline.Don'tusethe"enter"key.Thatwillexpandthefield(block)andyouwillendupwithtwopageswhenyouprintit.Ifyouuseadifferentfontorcharactersizeyoumayneedtomakesomechangestogetittofitononepage.aaaa)!dxdx  dcccc)!dxdxP Pdeeee)!dxdx dgggg)!dxdx dcc)! dxdxuuuu)!dxdx($$   1  llll)!dxdx&P d dBBBB)!dxdxjf *2[2]Right-Aligned Paragraph Numbers..` ..` 23  Ԁ..0` ..` jy *2[3]Right-Aligned Paragraph Numbers..` ..`  .. 23  Ԁ` ..` 0 .. j *2[4]Right-Aligned Paragraph Numbers..` ..`  .. ..23  Ԁ .. 0..6k$Triangle0   dPages&0 d d d  3sy2Right-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3| <6X9`(Courierd6X@K@( T$  ((3m$ zT!   ݊)zPages((3m$ zT!   ((3m$ zT!    * ~m&   _:Addordeleteanydefinitionsasappropriateforthisagreement.Ifyouaddordeleteanydefinitionsyoumay  needtochangethealphabeticalletters.##::#  @m"   _ ::PARTD:CertificationRegardingDrugFreeWorkplaceRequirements #:Y###::# _3:Hitthe"Find"key(F2)tofindandreplaceallthe*throughoutthedocument.Each*requiresyoutofillinyour  specificinformation.HSPages&d9 Z(Times New Roman j *2[5]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h23  Ԁ..0h..hj *2[6]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h..23  Ԁh..h0..j *2[7]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....23  Ԁ..0..j *2[8]Right-Aligned Paragraph Numbers..` ..`  .. ..h..h....p..p23  Ԁ..0p..p<6X9`(CourierXx6X@KX@<6X9`(Courierd6X@K@02A`Helvetica`2PkCP02A`Helvetica,:2PkC,P02A`Helvetica|M2PkCP22A"HelveticaBold 2p}wC /2A`Helveticad^MC2PkC^P/2A`HelveticadE5>2PkCEP<6X9`(CourierXx6X@KX@<6X9`(Courierd6X@K@02A`Helvetica`2PkCP02A`Helvetica,:2PkC,P02A`Helvetica|M2PkCP22A"HelveticaBold 2p}wC /2A`Helveticad^MC2PkC^P/2A`HelveticadE5>2PkCEP<6X9`(CourierXx6X@KX@<6X9`(Courierd6X@K@02A`Helvetica`2PkCP02A`Helvetica,:2PkC,P02A`Helvetica|M2PkCP22A"HelveticaBold 2p}wC /2A`Helveticad^MC2PkC^P/2A`Helveticad2PkCP/2A`HelveticadE5>2PkCEP<6X9`(Courierd6X@K@&@ Z6Times New Roman RegularPages  @m"   _ ::PARTC:  CertificationRegardingDrugFreeWorkplaceRequirements #Yq:###YqY#&d9 Z(Times New Roman   @m"   _ ::PARTA:0  CertificationRegardingDebarment,Suspension,andOtherResponsibilityMatters{ {  0 X 0X{ X{ PrimaryCoveredTransactions #Yq:###YqY# @ ~m&   _3:Explainthedutiesoftherecipient'sprojectmanager.Thisistheindividualwhoisresponsibleforthedaytoday  operationsoftheagreement,accomplishesthetasksandprobablypreparesthereports,etc. _3:Therecipient'sResponsibleOfficeristhepersonresponsibleforsigningtheagreementandisresponsiblefor  makingsureallworkiscompletedasspecifiedintheagreement.Don'tgetthismixedupwiththeProjectManagerwhoisthepersonresponsibleforthedaytodayoperationsandaccomplishestheprojectwork.  @m"   _ ::PARTB:0  CertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusion{ {  0 X 0X{ X{ LowerTierCoveredTransactions #Yq:###YqY#&d9 Z(Times New Roman  ~m&   :_Thisisanewrequirementandisrequiredinallagreements.##:*# _3:Selectoneofthefourparagraph"C"sbelowasappropriate.EducationalInstitution,orNonProfit  Organization,orCommercial(forprofit)Organizationandindividual,orHospital. _3:Selectthesecondparagraph"F"belowonlyifthegranteeisanindividual. u_3:Useparagraph"G"belowiftheagreementisexpectedtoexceed$100,000overthelifeoftheagreement.The  recipientmustcompletetheDI2010certificationform.YoumaywanttosupplytherecipientwithStandardFormLLL,DisclosureofLobbyingActivities,forsubmittingtherequiredreportsiftheyhaveconductedanyactivitiesthatrequirereporting.TheLLLFormisfoundintheFARinthe"FormsAuthorizedForLocalReproduction"sectionortheOMBwebsite3:3::4_ 6O  5  http://www.whitehouse.gov/OMB/grants/index.html6=6OQ  7_#3:3:#.Therecipient $$ mustreportanyactionsemiannuallyby(September30andMarch30).ReportsarerequiredtobesenttoAgencyHeadquartersbyOctober15andApril15forconsolidationtotheDepartment.ProceduresarefoundinFAR3.803,CertificationandDisclosure. X   &d9 Z(Times New Roman  5_3:Identifytherespectiveroles,responsibilities,obligations,andaccountabilitywhicheachparticipanttothe  agreementwillassumeinitsefforttoachievethestatedjointobjectives.Listeverythingtherecipientisrequiredtoperformandhowtheprojectandperformancewillbemeasuredtoevaluatetheobjectives.Providethedetailsfortheresources,suchasservices,facilities,equipment,materials,supplies,personnel,thattheAgencyandtherecipientwillprovide,andascheduleindicatingwhentheywillbeprovided.Youmaywanttoaddanotherparagraph("The*andtheAgencymutuallyagreeto:")foreverythingtherecipientandAgencyagreetodotogether.Thisparagraphmaybethefirstorlastparagraphtothissection. http://www.whitehouse.gov/OMB/grants/index.html " {m'   _3:3XUX3:(#**A1**** X WWW(#Page  2  ڀof, Pages11  #3:X3XUV# _3:Aftercompletingthe*informationinthe"Purpose"paragraphbelow,addashortsentence(inbroadterms)  explainingwhatisgoingtobeaccomplishedbythisagreement.Don'tgetthisconfusedwiththenextparagraph,"Objective",whichistobeexplainedindetail.ThesecannotbesomethingAgencyisrequiredtocompleteorthisprojectwillneedtobeaccomplishedbycontractaction. _3:Forcooperativeagreements,provideanexplicitstatementofthenature,character,andextentofanticipated  Agencyinvolvement.ThisstatementmustbedevelopedwithcaretoavoidunnecessarilyincreasingtheAgencysliabilityunderthecooperativeagreement.Enterasmanyitemsasyouneedbelow,however,paragraph#4belowshouldbethelastitemfor"TheAgencyagreesto". _3:Selectoneofthetwoparagraph"IV"sbelow.Agreementsmaynotexceed5years. _3:SendtherecipientacopyoftheSF3881formwhensendingthemtheaward.Itistheirresponsibilityto  completeitandsendittotheirrespectiveAgencypaymentoffice. ~m&   _3:Selecteither"advancepayment"or"reimbursement".Ifbothmethodsofpaymentwillbeusedjustdeletethe*. _3:Iftherecipientdoesn'thavetheSF270andSF272formssendthemsomewiththeawardorprovidethemwith  theinternetsitewheretheycanfindtheforms.Thatsiteis:4;_6O  5  http://www.whitehouse.gov/OMB/grants/index.html66O   7_7   _3:Ifreimbursementpaymentsareusedexclusively,deletethefollowingtwoparagraphs. _3:_Addanypropertyrequirementstothefollowingparagraphoraddadditionalparagraphsaboutproperty  requirementsspecifictothisagreement.Youdonothavetheauthoritytoindemnifyorholdharmlessanyonein  anyagreement(seeyourRegionalSolicitorforapproval).If_Agency__will_Ԁallowtherecipienttouseany_Agency  __property_Ԁorequipmentstatewhowillberesponsibleforthemaintenance,repair,damage,destruction,security,etc. @_3:Includethefollowingparagraphinallagreementsiftherecipientisexpectedtopurchaseanysuppliesor  serviceswithFederalfunds.ReviewtheBudgetInformationontheSF424Atoseeiftherecipientwillbeauthorizedtopurchaseanything.) ~m&   _3:Thisparagraphisrequiredinallgrantsandcooperativeagreements.Table_A>Q 0form[3](1)(a)0..0..23  0..>d 0form[4](1)(a)0..0..0..23  0..>w 0form[5](1)(a)0..0..0..0..23  0..> 0form[6](1)(a)0..0..0..0..0..23  0..> 0form[7](1)(a)0..0..0..0..0..0..23  0..> 0form[8](1)(a)0..0..0..0..0..0..0..23  0..AP456789 9GOW]emu{form(1)(a)(1)(a)i.(1)(a)(i)1)a)3#37=CIQYag1.a.i.(1)(a)(i)1)a);i) zT!   _X,X3XUXXX, 7 @dd AGREEMENTSWITHINSTITUTIONSOFHIGHEREDUCATION,  @v v HOSPITALSANDOTHERNONPROFITORGANIZATIONS   @`` RuralFireAssistance #3:X3XUH#3XUX3:Ԉ  #3:X3XUȿ#@_ 12/14/2000  03/01/01 _ԀVersion g 3:3:Thefollowingformsmustbecompletedbytherecipientpriortotheinitiationoftheagreement.TheSFformsand  I applicableOMBCircularsmaybefoundontheInternetatthefollowingsite:49 6O  5  http://www.whitehouse.gov/OMB/grants/index.html66Oz  7 v     qk  qk0 `   SF424,ApplicationforFederalAssistanceqk݌ m ` (#` (# Ќ    qk  qkH0 `   SF424A,BudgetInformation_Nonconstruction_ԀProgramsqkHc݌ 6 ` (#` (# Ќ    qk  qk60 `   SF424B,Assurances_Nonconstruction_ԀProgramsqk6Q݌ ` (#` (# Ќ  Thisformwillbecompletedbytherecipientwhentheyexecutetheagreement.  qk  qkk0 `   DI2010,CertificationRegardingDebarment,SuspensionandOtherResponsibilityMatters,Drug  Z  FreeWorkplaceRequirementsandLobbying(Thisformislocatedattheendofthismodel)qkk݌ ` (#` (# Ќ  #3:3:#3:3:   `     h      p   ThisagreementshallonlybeusedinaccordancewiththeDOIappropriationactofFY01,RuralFireAssistance.Youmaynotaddsubjectitemstotheprojectmanagementplan,however,youarenotrequiredtouseallthreeoftheitemslisted.Theexamplesgivenarenotacompletelistingandotherprojectsmaybedevelopedaslongastheycomplywith training,equipmentpurchase,andpreventionactivitiesonacostsharebasis.#3:3:#3:3:  A.Informationwillneedtobefilledinthatisspecifictoeachagreement.Someofthesections,suchasSectionI,II,andIII,areobviousandtheothersaremarkedwitha*.Thefollowingprocedureswillhelpyoufindallthespacesthatrequireafillinorachoicetobemadeinthetext:0  1.StartwithyourcursoratthebeginningofthemodelagreementandhittheF2(FindandReplace)key.At v thebottomofthescreenyouwillseetheFindandReplacetextboxappear. (#(# 0  2.IntheFindboxtypeinthe*(allthespacestobefilledorchoicesaremarkedwith*). (#(# 0  3.WithyourmouseclickonFindNextandyourcursorwillautomaticallymovetothefirst*.Youwillneedtobackspace(toerasethe*)andtypeintheinformationforyouragreementormakethechoiceintext. (#(# 0  4.WiththemouseclickonFindNexttomovetothenext*andthenext*willappear. (#(# 0  5.Keepdoingthisuntilyoureachtheendofthedocument. (#(# B.EdittheAgreementNumber(****)intheHeader.Onceyouhavefilledinthenewnumber,youwillneedtoexitoutoftheHeaderbyclickingonFile,Close.Thefirstpagenumberin"Page___of___"intheHeaderwillstartwithPage2.Thesecondpagenumberiscreatedbyacodeonthelastpageofthedocument(Target(Pages)).Donotdeletethiscode.Thispagenumberdoesnotautomaticallychangeaspagesareadded.Youmustgeneratethedocument(ControlF9)inorderforittochange.Ifyoudonotgeneratethedocumentbeforeyouprint,WordPerfectwillaskyouifyouwouldliketo"generate"beforeyouprint,justanswer"Yes".:C."Comments"havebeenaddedthroughoutthisdocumentwithhelpfulinformationtoassistyouincompletingtheagreementeasierandfaster.Thecommentsarewithinanovalintheleftmarginandshowupinfulltextonlywhenyouusethemouseandclickontheoval.Clickontheovalontheleftofthisparagraphnow.D.Asyougothroughthedocumentdeletetheadministrativeparagraphsnotneeded.Selectoneoftheparagraphsifsimilarparagraphsareallowed.Ifyouhaveanyquestions,comments,orsuggestedchangespleasecontactyourProcurementAnalystorContractingOfficer.#3:3:C # /-9 XXX ~m   \$"Q ~m   *RS ddd Xdd Xdd XX%X%, dd ,td ,4td ,td ,td +  7& Q x73,Hd,3:Form15111(February1989)@ <#3:,3,Hd##3y3:UnitedStatesDepartmentoftheInterior#3:3y#3,Hd,3:Ԉ p= @ !<#3:,3,Hd#3y3:BureauofLandManagement#3:3y{#Ԉ    @ #<3  !3:ASSISTANCEAGREEMENT#3: !3 #Ԉ f  3,Hd,3:NOTE:Bysigningthisdocument,therecipientacceptsthisagreementandagreestoperforminaccordancewithalltheenclosedterms,conditions,and  \  documentsattachedhereto.#3:,3,Hdl# ;v,  ;@ 3^y _3:PAGE#3: _3^y#Ԁ13^y _3:OF#3: _3^y #Ԁ3^y _3:PAGES#3: _3^yY#Ԉ C9& x  v C *vv F *3^y _3:1.AGREEMENTNO.#3: _3^y#  Ѐ C9&d1  vv C *vv - *3^y _3:2.TASKORDERNO.#3: _3^y#  Ѐ C9&K   vv C *vv   *3^y _3:3.TYPEOFAGREEMENT(Checkone)  i  Ѐ#3: _3^y#&3^y _3:GRANT 2  Ѐ#3: _3^yJ#&3^y _3:COOPERATIVEAGREEMENT OuB&   vv &O4.NAME,ADDRESSANDPHONENO.OFASSISTANCEOFFICER#3: _3^y# l 9   9uv*&u 93^y _3:5.NAME,ADDRESSANDPHONENO.OFRECIPIENT#3: _3^y# l 9   OvB&&" & uv O3^y _3:6.NAME,ADDRESSANDPHONENO.OFASSISTANCEREPRESENTATIVE#3: _3^y # wD#  9vv*1(v 93^y _3:7.#3: _3^y~!#3Ey _3:ԀNAME,ADDRESSANDPHONENO.OFRECIPIENT'SPROJECTMANAGER#3: _3Ey!# wD)  OvB&1.  vv PO3^y _3:8.PROGRAMSTATUTORYAUTHORITY#3: _3^y"#Ԁ 9vv*O/v 93^y _3:9.STARTINGDATE#3: _3^yF##Ԁ OvB&O0 P vv PO3^y _3:10.EFFECTIVEDATE#3: _3^y##Ԁ 9vv*1v 93^y _3:11.COMPLETIONDATE#3: _3^y$#Ԁ OvB&2 P vv ^O3^y _3:12.TYPEOFRECIPIENT(Checkone) $3 Ѐ#3: _3^yA%#&3^y _3:STATE 4 Ѐ#3: _3^y%#&3^y _3:LOCALGOVERNMENT P5 Ѐ#3: _3^y5&#&3^y _3:INDIANTRIBALGOVERNMENT L6 Ѐ#3: _3^y&#&3^y _3:EDUCATIONALINSTITUTION 7 Ѐ#3: _3^y%'#&3^y _3:INDIVIDUAL 8 Ѐ#3: _3^y'#&3^y _3:FORPROFITORGANIZATION t9 Ѐ#3: _3^y(#&3^y _3:NONPROFITORGANIZATION p=: Ѐ#3: _3^y(#&3^y _3:OTHER(SPECIFY)#3: _3^y)#򀀀 9vv*9 ;v 93^y _3:13.FUNDINGINFORMATION $< Ӏ#3: _3^y)#3,Hd,3:RecipientAgency#3:,3,Hdm*#3^y _3: = Thisobligation$#3: _3^y*#򀀀󀀀3^y _3:$#3: _3^yl+#򀀀3^y _3: h? Previousobligation$#3: _3^y+#򀀀󀀀3^y _3:$#3: _3^yT,#򀀀3^y _3: A Totalobligation$#3: _3^y,#򀀀󀀀3^y _3:$#3: _3^yP-#򀀀3^y _3: C ShareRatio#3: _3^y-#򀀀%󀀀򀀀% OvB&F ^ vv O3^y _3:14.ACCOUNTINGANDAPPROPRIATIONDATA#3: _3^y.#  W!G Ѐ OvB& !!H  v &O3^y _3:15.PROJECTTITLEANDBRIEFSUMMARYOFTHEPURPOSEANDOBJECTIVES#3: _3^y/# q">#I  OvB&+&&N & v O3^y _3:16a.NAMEANDTITLEOFSIGNER(Typeorprint)#3: _3^yp0# |'I(O Ѐ 9vv*((Pv 93^y _3:17a.NAMEANDTITLEOFASSISTANCEORDERINGOFFICER(Typeorprint)#3: _3^y<1# |'I(Q Ѐ Kvu:&((R  vv K3^y _3:16b.RECIPIENT c)0*S ̀ *+V @6#3: _3^yE2#3,Hd,3:(AuthorizedSignature)#3:,3,Hd83#3^y _3:Ԉ 4vvu#p+=,Wvu 4#3: _3^y3#3,Hd,3:16c.DATESIGNED#3:,3,Hd 4# c)0*X @ 8vvu'*v+Zvvu 83^y _3:17b.UNITEDSTATESOFAMERICA c)0*[ BY򀀀#3: _3^y4# *+^ @f3,Hd,3:(SignatureofAssistanceOfficer)#3:,3,Hd5#3^y _3:Ԉ 7vvu&p+=,_vvu 7#3: _3^y26#3,Hd,3:17c.DATESIGNED#3:,3,Hd6# c)0*` 3)')*a 0  vvu 3  ,,a XXXVtV[3XUX3:I.StatementofJointObjectives     `     h      p   $  A.Purpose.ThisagreementismadeandenteredintobytheDepartmentoftheInterior, 5  *[BLM,BIA,_NPS_,_FWS_]andthe*[Nonprofit],forthepurposeofenhancingthefireprotectioncapabilityofruralfiredistricts.  B.Objective.Toprovideassistancein*training,equipmentpurchase,andprevention    activitiesonacostsharebasis.Toincreasefirefightersafety,enhancethefireprotectioncapabilitiesofruralfiredepartments,andenhanceprotectionintheurbanwildlandinterface.Toincreasethecoordinationbetweenlocal,State,Tribal,andFederalfirefightingresources.  C.Authority.  P.L.106291,MakingAppropriationsfortheDepartmentofInteriorandRelatedAgenciesfortheFiscalYearendingSeptember30,21001,andforOtherPurposes,whichstates,inpart,theDepartmentofInteriorwillprovideruralfireassistance.#3:X3XU7#3XUX3:    D.Benefits.Thepublic/*tribeswillbenefitbyhavingreducedfireloss,thedevelopmentoffire  preventionprograms,andthereductionofoccurrenceandintensityofwildlandfireswithintheurbaninterface.#3:X3XU=#3XUX3:II.Definitions.    A.Agreement:Thiscooperativeagreement.  B.AssistanceOfficer(AO):The*[agency]AssistanceOfficer.TheAOistheonlyindividualauthorizedtoobligatefunds,award,modifyorterminatetheagreement.TheAOisresponsibleformonitoringtheagreement,enforcingtheagreementprovisions,issuingtimelyperformanceandpaymentapprovals,terminatingtheagreement,andclosingouttheagreement.    B.ContractingOfficer(CO):The*[agency]ContractingOfficer.TheCOistheonlyindividualauthorizedtoobligatefunds,award,modifyorterminatetheagreement.TheCOisresponsibleformonitoringtheagreement,enforcingtheagreementprovisions,issuingtimelyperformanceandpaymentapprovals,terminatingtheagreement,andclosingouttheagreement.#3:X3XU\>#3XUX3: N%k**   C.AssistanceRepresentative(AR):The*[agency]AssistanceRepresentative.TheARwillbedesignatedforthepurposeofadministeringthetechnicalaspectoftheagreement.TheARisauthorizedtoclarifytechnicalrequirements,andtoreviewandapproveworkwhichisclearlywithinthescopeoftheworkspecifiedinthisagreement.TheARisnotauthorizedtoissuechangesorinanyotherwaymodifythisagreement.#3:X3XUB#3XUX3: *+G00   C.ContractingOfficersRepresentative(COR):The*[agency]ContractingOfficersRepresentative.TheCORwillbedesignatedforthepurposeofadministeringthetechnicalaspectoftheagreement.TheCORisauthorizedtoclarifytechnicalrequirements,andtoreviewandapproveworkwhichisclearlywithinthescopeoftheworkspecifiedinthisagreement.TheCORisnot  0)55 authorizedtoissuechangesorinanyotherwaymodifythisagreement.#3:X3XU!D#3XUX3:        D.*[agency.]Mayalsobereferredtoas*Bureau/Service.  E.TheCodeofFederalRegulations(CFR).  F.FiscalYear(FY):TheFederalfiscalyearwhichextendsfromOctober1ofoneyearthroughSeptember30ofthefollowingyear.  G.The*.Mayalsobereferredtoasrecipient.    H.NTE:NottoExceed#3:X3XUaF#3XUX3:     I.TheOfficeofManagementandBudget(OMB)#3:X3XUNH#3XUX3:.     J.ProjectInspector(PI):The*[agency]projectinspector.Atthetimeofaward,a*[agency]employee(s)maybeappointedasthePI.Ifappointed,thePIwillberesponsibleforprovidingonsiteinspectionoftheworkandforgivingthe*representativeanyspecialinstructions,guidance,ortrainingnecessarytocompleteorperformthework.ThePIwillnotbeauthorizedtoissuechangesorinanywaymodifytheagreement.  K.ProjectManager:Therecipient'sProjectManager.*[  L.ResponsibleOfficial:Therecipient'sResponsibleOfficial.Theresponsibleofficialistheindividualwhoisauthorizedtoactfortherecipientsorganizationandcommittherecipienttocompliancewiththetermsandconditionsofthisagreement. #3:X3XUH#3XUX3:III.ProjectManagementPlan. f!,&   A.The*[recipient]agreesto:(Examples)#3:X3XUȐL#3XUX3: Z#.(    ` 1.Training:Provide/attendwildlandfiresuppressiontraining(includescostsofassociatedtravelinaccordancewithFederalTravelRegulations).Assistintheplanningandcoordinationofthewildlandfiretrainingcourse(s).Providewildlandfiretraininginstructor.Providewildlandfiretrainingmaterialsandconferenceroomfacilities.   ` 2.Equipmentpurchase:Purchasewildlandpersonalprotectiveequipmentforfirefighters.Purchasesuppliesandmaterialsassociatedwithwildlandfirefightingactivities,i.e.,fusees,hose,adapters,nozzles,driptorches,etc.Purchaseofwildlandfiretools,radios,engines,trucks,pumpsandpumppackagestobeidentifiedbytypesandquantities.   ` 3.Preventionactivities:Establishafiresafecommunityprotectionprogram.Preparetriageassessmentsforurbaninterfaceareas.Developacommunitypreventionprogram.Cooperate  0;5 withPlanningandZoningtodevelopstandardsforwildlandurbaninterfaceareas.#3:X3XUCM#3XUX3:  B.The*[agency]agreesto:(Examples)   ` 1.Training:Assistinidentifyingtrainingopportunitiesanddevelopingtrainingplansforruralfirefighters.Provideinstructor(s)forwildlandtrainingcourse(s).Providewildlandfiretrainingmaterialsandconferenceroomfacilities.#3:X3XUQ#3XUX3:      ` 2.EquipmentPurchase:Purchaseequipmentand/orfacilitatetransferwithinapplicableregulations.(Handreceiptortransfer)Typesofequipmentmayinclude,butisnotlimitedto,trucks,engines,pumps,pumppackages,tools,supplies,materials,officeequipment,etc.   ` 3.Preventionactivities:Assistinestablishingafiresafecommunityprotectionprogram,preparingtriageassessmentsforurbaninterfaceareas,anddevelopingacommunitypreventionprogram.CooperatewithPlanningandZoningtodevelopstandardsforwildlandurbaninterfaceareas.#3:X3XUcS#3XUX3:     ` 4.Providepaymentstothe*inaccordancewithSection*,FinancialSupport,andSection*,Payments,ofthisagreementandapplicableOMBandTreasuryRegulations.#3:X3XUV#3XUX3:'IV.TermofAgreement.Thisagreementshallbecomeeffectiveonthedateofsignatureofthe  *[agency]*Contracting/#3:X3XU5W#3XUX3:ԀAssistanceOfficerandshallremainineffectfortheremainderofFY*,unless  terminatedinaccordancewiththeprovisionsof43CFRSubpartF,Section12.961.Thisagreementmayberenewedforsubsequent_FYs_Ԁ(NTEatotaloffive),subjecttotheavailabilityofFederalfunding,bymutualwrittenmodificationsignedbybothpartiestothisagreement.IV.TermofAgreement.Thisagreementshallbecomeeffectiveonthedateofsignatureofthe x!  *[agency]*Contracting/#3:X3XUX#3XUX3:ԀAssistanceOfficerandshallremainineffectuntil*,unlessterminatedin r"! accordancewiththeprovisionsof43CFR,SubpartF,Section12.961.V.FinancialSupport. `"%$   A.ThisagreementshallbefundedeachFYbasedontheavailabilityof*[agency]funding.The*herebyreleasesthe*[agency]fromallliabilityduetofailureofCongresstoappropriatefunds.  B.FundsobligatedbutnotexpendedinoneFYcanbecarriedforwardandexpendedinthesubsequentFY.  C.$*representstheNTEamountforwhichthe*[agency]willberesponsibleunderthetermsofthisagreement.The*[agency]shallnotbeobligatedtopayfornorshallthe*beobligatedtoperformanyeffortthatwillrequiretheexpenditureofFederalfundsabovetheNTEamount.  C.$*representstheannualNTEamountforwhichthe*[agency]willberesponsibleunderthetermsofthisagreement.EachmodificationissuedwillspecifytheNTEamountforthatmodification.The*[agency]shallnotbeobligatedtopayfornorshallthe*beobligatedtoperformanyeffortthat  0332 willrequiretheexpenditureofFederalfundsabovetheNTEamountspecifiedinthatmodification.  D.Costsharingforthisagreementshallbeinaccordancewith43CFR,SubpartF,Section12.923.[**Addpercentsharewhenpolicyisapproved.]  C.$*($20,000annualcapsetby_Natl_ԀFirePlanSteeringGroup)representstheNTEamountforwhichthe*[agency]willberesponsibleunderthetermsofthisagreement.The*[agency]shallnotbeobligatedtopayfornorshallthe*beobligatedtoperformanyeffortthatwillrequiretheexpenditureofFederalfundsabovetheNTEamount.  C.$*($20,000annualcapsetby_Natl_ԀFirePlanSteeringGroup)#3:X3XUȋZ#3XUX3:ԀrepresentstheannualNTE /921 amountforwhichthe*[agency]willberesponsibleunderthetermsofthisagreement.Each  0332 modificationissuedwillspecifytheNTEamountforthatmodification.The*[agency]shallnotbeobligatedtopayfornorshallthe*beobligatedtoperformanyeffortthatwillrequiretheexpenditureofFederalfundsabovetheNTEamountspecifiedinthatmodification.  D.Costsharingforthisagreementshallbeinaccordancewith43CFR,SubpartFC,Section_12.64923._ԀOtherFederalfunds#3:X3XUob#3XUX3:Ԁmaynotbeusedforcostsharing.Therequiredcostshareis90%   *[agency]/10%*[tribe/RFD].Cooperatorscontributionmaybeintheformofinkindservices.#3:X3XU[e#3XUX3:VI.Payments.     A. ` ElectronicFundsTransferPayments      ` 1.PaymentunderthisagreementwillbemadebytheGovernmentbyelectronicfundstransfer(throughtheTreasuryFedlinePaymentSystem(FEDLINE)ortheAutomatedClearingHouse(ACH)),orNationalInstituteofHealth(NIH)paymentsystem.   ` 2.Afteraward,butnolaterthan14daysbeforeaninvoiceoragreementfinancingrequestissubmitted,theRecipientshalldesignateafinancialinstitutionforreceiptofelectronicfundstransferpayments(SF3881),andshallsubmitthisdesignationtothefollowingaddress:[**Add_FWS_,BIA,_NPS_Ԁaddresses]   `  BureauofLandManagement   `  NationalBusinessCenter,BC630   `  DenverFederalCenter,Bldg.50   `  POBox25047   `  Denver,CO802250047   ` 3.Ifadesignationhasbeensubmittedtothe*[agency]underapreviousagreementitisnotnecessarytocompleteanotherSF3881unlessyouarechangingyourdesignationoffinancialinstitution.'  [  B.The*shallbeentitledtoreimbursement*oradvancepayment*atleastquarterlyuponsubmissionofanoriginalRequestforAdvanceorReimbursement,StandardForm(SF)270totheAR.Paymentsshallbegovernedbytheprovisionsof43CFRSubpartF,Section12.922and12.952.'  C.Ifadvancepaymentsaremadethe*mustsubmitaFederalCashTransactionReport,SF272totheAssistanceOfficer15workingdaysfollowingtheendofeachquarter.  D.Advancepaymentsshallbemadeonlyinamountsnecessarytomeetcurrentdisbursementneedsandshallbescheduledsothatthefundsareavailableonlyimmediatelypriortotheirdisbursement.VII.PropertyManagementandDisposition. .36 K  Any*[agency]propertyusedorotherpropertyacquiredunderthisagreement,including  0:;; intangiblepropertysuchascopyrightsandpatentsshallbegovernedbytheprovisionsof43CFR,SubpartF,Section12.930through12.937.#3:X3XUVf#Ԁ3XUX3:ԀEachpartyagreesthatitwillberesponsibleforitsown  actsandtheresultsthereofandshallnotberesponsiblefortheactsoftheotherpartyandtheresults_thereof.Eachparty,therefore,agrees,totheextentauthorizedbyapplicablelawswillassumeallrisksandliabilitytoitself,itsagentsoremployees,foranyinjurytopersonsorpropertyresultingfromanyoperationsofitsagentsoremployeesunderthisagreement,andforanyloss,cost,damage,orexpenseresultingatanytimefromanyandallclausesduetoanyacts,ornegligence,orthefailuretoexerciseproperprecautionsoforbyitselforitsownagentstothisagreement.The*[agency]assumesnoliabilityforanyactionsoractivitiesconductedunderthisagreementexcepttotheextentthatrecourseorremediesareprovidedbyCongressundertheFederalTortClaimsAct[28U.S.C.1346(b),2401(b),26712680,asamendedby_P.L._Ԁ89506,80Stat.306.#3:X3XUIp#3XUX3:   VIII.DeliverablesandReports.     Submitonecopyofanannualperformancereporttothe*[agency]within90daysaftertheendoftheFY.Theperformancereportmustbepreparedinaccordancewith43_CFR_,SubpartF,Section12.951andaddressitemssuchasacomparisonofactualaccomplishmentswithestablishedgoals,reasonswhygoalsmaynothavebeenmet,costoverrunsandanyotherpertinentinformation.IX.KeyOfficials.    A.*ContractingOfficer(CO)/AssistanceOfficer(_AO_)   ` Address   ` TelephoneNumber  B.*ContractingOfficersRepresentative(COR)/AssistanceRepresentative(AR)   ` Address   ` TelephoneNumber  C.*ProjectInspector(PI)   ` Address   ` TelephoneNumber#3:X3XUȁt#3XUX3:  D.*ResponsibleOfficial   ` Address   ` TelephoneNumber#3:X3XUȳx#3XUX3:  E.*ProjectManager   ` Address   ` TelephoneNumber#3:X3XUey#3XUX3:#3:X3XUz#3XUX3:X.SpecialTermsandConditions. - ()   _A._ԀOrderofPrecedence  0*,   Anyinconsistencyinthisagreementshallberesolvedbygivingprecedenceinthefollowingorder:(a)Anynationalpolicyrequirementsandadministrativemanagementstandards;(b)requirementsoftheapplicableOMBCircularsandTreasuryregulations;(c)43_CFR_ԀPart12;(d)specialtermsandconditions;and(e)allAgreementsections,documents,exhibits,andattachments.  B.Modifications  Thisagreementmaybemodifiedbywrittenagreementsignedbybotha*[recipient]andtheCO/_AO_.Administrativechanges(i.e._AO_Ԁnamechange)whichdonotchangetheprojectmanagementplan,_NTE_Ԁamount,etc.orotherwiseaffecttherecipientmaybesignedunilaterallybytheCO/_AO_.[  C.ProcurementProcedures  Itisanationalpolicytoplaceafairshareofpurchaseswithminoritybusinessfirms.TheDepartmentoftheInteriorisstronglycommittedtotheobjectivesofthispolicyandencouragesallrecipientsofitsgrantsandcooperativeagreementstotakeaffirmativestepstoensuresuchfairness.Positiveeffortsshallbemadebyrecipientstoutilizesmallbusinesses,minorityownedfirms,andwomen'sbusinessenterprises,wheneverpossible.RecipientsofFederalawardsshalltakeallofthefollowingstepstofurtherthisgoal:   ` 1.Ensurethatsmallbusinesses,minorityownedfirms,andwomen'sbusinessenterprisesareusedtothefullestextentpracticable.   ` 2.Makeinformationonforthcomingopportunitiesavailableandarrangetimeframesforpurchasesandcontractstoencourageandfacilitateparticipationbysmallbusinesses,minorityownedfirms,andwomen'sbusinessenterprises.   ` 3.Considerinthecontractprocesswhetherfirmscompetingforlargercontractsintendtosubcontractwithsmallbusinesses,minorityownedfirms,andwomen'sbusinessenterprises.   ` 4.Encouragecontractingwithconsortiumsofsmallbusinesses,minorityownedfirmsandwomen'sbusinessenterpriseswhenacontractistoolargeforoneofthesefirmstohandleindividually.   ` 5.Usetheservicesandassistance,asappropriate,ofsuchorganizationsastheSmallBusinessDevelopmentAgencyinthesolicitationandutilizationofsmallbusiness,minorityownedfirmsandwomen'sbusinessenterprises.XI.GeneralProvisions. 0*()   A.NationalPolicyRequirementsandAdministrativeManagementStandards.AllapplicablenationalpolicyrequirementsandadministrativemanagementstandardsassetforthintheOfficeofManagementandBudget,FinancialManagementDivision,DirectoryofPolicyRequirementsandAdministrativeStandardsforFederalAidProgramsareincorporatedbyreference.  0./   B.43_CFR_ԀPart12,AdministrativeandAuditRequirementsandCostPrinciplesforAssistanceProgramsisincorporatedbyreference.  C.OMBCircularA21,CostPrinciplesforEducationalInstitutionsandthecompletedCertificateForIndirectCostisincorporatedbyreference.  C.OMBCircularA122,CostPrinciplesforNonprofitOrganizationsisincorporatedbyreference.  C.FederalAcquisitionRegulation(FAR)at48_CFR_ԀPart31isincorporatedbyreference.  C.45_CFR_ԀPart74,AppendixE,PrinciplesforDeterminingCostsApplicabletoResearchandDevelopmentUnderGrantsandContractswithHospitals,isincorporatedbyreference.  D.43CodeofFederalRegulations(_CFR_)Part12,AppendixAtoSubpartD,CertificationRegardingDebarment,Suspension,andOtherResponsibilityMattersPrimaryCoveredTransactionandcompletedFormDI2010areincorporatedbyreference.'  E.43_CFR_ԀPart12,AppendixCtoSubpartD,CertificationRegardingDrugFreeWorkplaceRequirements,AlternateI(Granteesotherthanindividuals)andcompletedFormDI2010areincorporatedbyreference.  F.43_CFR_ԀPart12,AppendixCtoSubpartD,CertificationRegardingDrugFreeWorkplaceRequirements,AlternateII(GranteesWhoareIndividuals)andcompletedFormDI2010areincorporatedbyreference.o  G.3lU.S.C.1352,CertificationRegardingLobbyingandcompletedFormDI2010areincorporatedbyreference.  H.SingleAuditActAmendmentsof1996,PublicLaw104156,110Stat.1396,31U.S.C.75017and43_CFR_,Part12,isincorporatedbyreference.  I.ComplianceWithBuyAmericanAct.PursuanttoSec.307oftheDepartmentoftheInteriorandRelatedAgenciesAppropriationsActof2000,PublicLaw106113,beadvisedofthefollowing:   ` 1.Noneofthefundsmadeavailableinthisagreementmaybeexpendedbyarecipientunlesstherecipientagreesthatinexpendingthefundstherecipientwillcomplywithsections2through4oftheActofMarch3,1933(41U.S.C.10a10c;popularlyknownasthe"BuyAmericanAct").   ` 2.PurchaseofAmericanmadeequipmentandproducts.InthecaseofanyequipmentorproductthatmaybeauthorizedtobepurchasedwithfinancialassistanceprovidedusingfundsmadeavailableinthisAct,itisthesenseoftheCongressthatentitiesreceivingtheassistanceshould,inexpendingtheassistance,purchaseonlyAmericanmadeequipmentandproducts.  0~85    ` 3.Recipientalsoagreestofollowtheproceduresin43CFRPart12,SubpartE,Section12.700BuyAmericanRequirementsforAssistancePrograms.('  J.OppositiontoAnyLegislation.RecipientshallnotuseanypartoftheGovernmentsfundsforanyactivityorthepublicationordistributionofliteraturethatinanywaytendstopromotepublicsupportoroppositiontoanylegislativeproposalonwhichCongressionalactionisnotcomplete.Q  K.Endorsements.Recipientshallnotpublicizeorotherwisecirculate,promotionalmaterial(suchasadvertisements,salesbrochures,pressreleases,speeches,stillandmotionpictures,articles,manuscriptsorotherpublications)whichstatesorimpliesgovernmental,Departmental,bureau,orgovernmentemployeeendorsementofaproduct,service,orpositionwhichtherecipientrepresents.NoreleaseofinformationrelatingtothisawardmaystateorimplythattheGovernmentapprovesoftherecipientsworkproducts,orconsiderstherecipientsworkproducttobesuperiortootherproductsorservices.Allinformationsubmittedforpublicationorotherpublicreleasesofinformationregardingthisprojectshallcarrythefollowingdisclaimer:0  TheviewsandconclusionscontainedinthisdocumentarethoseoftheauthorsandshouldnotbeinterpretedasrepresentingtheopinionsorpoliciesoftheU.S.Government.MentionoftradenamesorcommercialproductsdoesnotconstitutetheirendorsementbytheU.S.Government. (#(# RecipientmustobtainpriorGovernmentapprovalforanypublicinformationreleasesconcerningthisawardwhichrefertotheDepartmentoftheInteriororanybureauoremployee(bynameortitle).Thespecifictext,layoutphotographs,etc.oftheproposedreleasemustbesubmittedwiththerequestforapproval.Arecipientfurtheragreestoincludethisprovisionina_subaward_Ԁtoand_subrecipient_,exceptfora_subaward_ԀtoaStategovernment,alocalgovernment,ortoafederallyrecognizedIndiantribalGovernment.'  L.IncreasingSeatBeltUseintheUnitedStates.Recipientsofgrants/cooperativeagreementsand/orsubawardsareencouragedtoadoptandenforceonthejobseatbeltusepoliciesandprogramsfortheiremployeeswhenoperatingcompanyowned,rented,orpersonallyownedvehicles.Thesemeasuresinclude,butarenotlimitedto,conductingeducation,awareness,andotherappropriateprogramsfortheiremployeesabouttheimportanceofwearingseatbeltsandtheconsequencesofnotwearingthem.#3:X3XUUz# ,  0*Z,/ b :AP456789(03;bHHXX  TRX3'X3' Letter3' Letter3'T^)E@ U.S.DepartmentoftheInterior   @v v  3&C%3:CertificationsRegardingDebarment,Suspensionand w[ @| | OtherResponsibilityMatters,DrugFreeWorkplace@ggRequirementsandLobbying@ (,H$H$( ;#3:%3&C#33:Personssigningthisformshouldrefertotheregulationsreferenced  belowforcompleteinstructions:CertificationRegardingDebarment,Suspension,andOtherResponsibilityMattersPrimaryCoveredTransactions The   prospectiveprimaryparticipantfurtheragreesbysubmittingthisproposalthatitwillincludetheclausetitled,"CertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusionLowerTierCoveredTransaction,"providedbythedepartmentoragencyenteringintothiscoveredtransaction,withoutmodification,inalllowertiercoveredtransactionsandinallsolicitationsforlowertiercoveredtransactions. Seebelow F* forlanguagetobeusedorusethisformforcertificationandsign.(See    AppendixAofSubpartDof43CFRPart12.)  CertificationRegardingDebarment,Suspension,IneligibilityandVoluntaryExclusionLowerTierCoveredTransactions(SeeAppendixBofSubpartDof43CFRPart12.)CertificationRegardingDrugFreeWorkplaceRequirementsAlternateI.(GranteesOtherThanIndividuals)andAlternateII.(GranteesWhoareIndividuals)(SeeAppendixCofSubpartDof43CFRPart12)Signatureonthisformprovidesforcompliancewithcertificationrequirementsunder43CFRParts12and18.ThecertificationsshallbetreatedasamaterialrepresentationoffactuponwhichreliancewillbeplacedwhentheDepartmentoftheInteriordeterminestoawardthecoveredtransaction,grant,cooperativeagreementorloan.#3:3o#3&C%3: G+# (,HVHV( ( #  HX #3:%3&C#33:i5J3#h L'"C!< `EHC!zdt{ " i#3:3ɵ# 33: $     #3:3c#3y3: CHECK򀀀IFTHISCERTIFICATIONISFORAPRIMARYCOVEREDTRANSACTIONANDISAPPLICABLE. #3:3y֩#33: &   l[HHlP X`h!$p&( +x-/(24609;=Hl (1) l Theprospectiveprimaryparticipantcertifiestothebestofitsknowledgeandbelief,thatitanditsprincipals: ( ~[HHl%P X`h!$p&( +x-/(24609;=HHlX~ l (a)0 % Arenotpresentlydebarred,suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedbyanyFederal D(* departmentoragency; %$%$  l (b)0 % Havenotwithinathreeyearperiodprecedingthisproposalbeenconvictedoforhadaciviljudgmentrenderedagainstthemfor cG- commissionoffraudoracriminaloffenseinconnectionwithobtaining,attemptingtoobtain,orperformingapublic(Federal,Stateorlocal)transactionorcontractunderapublictransaction;violationofFederalorStateantitruststatutesorcommissionofembezzlement,theft,forgery,bribery,falsificationordestructionofrecords,makingfalsestatements,orreceivingstolenproperty; %$%$ {XHHl%P X`h!$p&( +x-/(24609;=HHl%X{ l (c)0 % Arenotpresentlyindictedfororotherwisecriminallyorcivillychargedbyagovernmentalentity(Federal,Stateorlocal)with  2 commissionofanyoftheoffensesenumeratedinparagraph(1)(b)ofthiscertification;and %$%$ ~[HHl%P X`h!$p&( +x-/(24609;=HHl%P X~ l (d)0 % Havenotwithinathreeyearperiodprecedingthisapplication/proposalhadoneormorepublictransactions(Federal,Stateorlocal) 3" 5 terminatedforcauseordefault. %$%$ (2)0 l Wheretheprospectiveprimaryparticipantisunabletocertifytoanyofthestatementsinthiscertification,suchprospectiveparticipant R$6"8 shallattachanexplanationtothisproposal. l$l$    i5J3#h L72C!< `EHq&C!zdt{ %" i q&U$; #3:3z#3y3:   CHECK򀀀IFTHISCERTIFICATIONISFORALOWERTIERCOVEREDTRANSACTIONANDISAPPLICABLE. #3:3y$#33: 7)'=   (1)0 l Theprospectivelowertierparticipantcertifies,bysubmissionofthisproposal,thatneitheritnoritsprincipalsispresentlydebarred, x*\(? suspended,proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromparticipationinthistransactionbyanyFederaldepartmentoragency. l$l$ (2)0 l Wheretheprospectivelowertierparticipantisunabletocertifytoanyofthestatementsinthiscertification,suchprospectiveparticipant `-D+C shallattachanexplanationtothisproposal. #3:3#). ,Dl$l$ 33:    -HHHl%P X-  #3:3ɪ#3,Hd,3:DI2010 /c-F   June1995  (ThisformreplacesDI1953,DI1954,  DI1955,DI1956andDI1963)#3:,3,Hd>#33:  0.I ^)E  ^,, ^  #3:3#33:-1HHl%P XH1շ  l5J6&"h \72 P!< `EH,P!dt " l ,   3y3 CHECK򀀀IFTHISCERTIFICATIONISFORANAPPLICANTWHOISNOTANINDIVIDUAL.#33yƺ# )   AlternateI.(GranteesOtherThanIndividuals)A.Thegranteecertifiesthatitwillorcontinuetoprovideadrugfreeworkplaceby: l (a)0 % Publishingastatementnotifyingemployeesthattheunlawfulmanufacture,distribution,dispensing,possession,oruseofacontrolled  substanceisprohibitedinthegrantee'sworkplaceandspecifyingtheactionsthatwillbetakenagainstemployeesforviolationofsuchprohibition; %$%$  l (b) % Establishinganongoingdrugfreeawarenessprogramtoinformemployeesabout    [HHl%vP X`h!$p&( +x-/(24609;=HHl%P X l  % (1)0 v Thedangersofdrugabuseintheworkplace;~ R v$v$  l  % (2)0 v Thegrantee'spolicyofmaintainingadrugfreeworkplace;% v$v$  l  % (3)0 v Anyavailabledrugcounseling,rehabilitation,andemployeeassistanceprograms;and v$v$  l  % (4)0 v Thepenaltiesthatmaybeimposeduponemployeesfordrugabuseviolationsoccurringintheworkplace;s G v$v$ [HHl%P X`h!$p&( +x-/(24609;=HHl%vP X l (c)0 % Makingitarequirementthateachemployeetobeengagedintheperformanceofthegrantbegivenacopyofthestatementrequired   byparagraph(a); %$%$  l (d)0 % Notifyingtheemployeeinthestatementrequiredbyparagraph(a)that,asaconditionofemploymentunderthegrant,theemployee  will %$%$ [HHl%vP X`h!$p&( +x-/(24609;=HHl%P X l  % (1)0 v Abidebythetermsofthestatement;and@v$v$  l  % (2)0 v Notifytheemployerinwritingofhisorherconvictionforaviolationofacriminaldrugstatuteoccurringintheworkplaceno  laterthanfivecalendardaysaftersuchconviction; v$v$ [HHl%P X`h!$p&( +x-/(24609;=HHl%vP X l (e)0 % Notifyingtheagencyinwriting,withintencalendardaysafterreceivingnoticeundersubparagraph(d)(2)fromanemployeeor  otherwisereceivingactualnoticeofsuchconviction.Employersofconvictedemployeesmustprovidenotice,includingpositiontitle,toeverygrantofficeronwhosegrantactivitytheconvictedemployeewasworking,unlesstheFederalagencyhasdesignatedacentralpointforthereceiptofsuchnotices.Noticeshallincludetheidentificationnumbers(s)ofeachaffectedgrant; %$%$  l (f)0 % Takingoneofthefollowingactions,within30calendardaysofreceivingnoticeundersubparagraph(d)(2),withrespecttoany k  employeewhoissoconvicted %$%$ [HHl%vP X`h!$p&( +x-/(24609;=HHl%P X l  % (1)0 v Takingappropriatepersonnelactionagainstsuchanemployee,uptoandincludingtermination,consistentwiththe " requirementsoftheRehabilitationActof1973,asamended;or v$v$  l  % (2)0 v Requiringsuchemployeetoparticipatesatisfactorilyinadrugabuseassistanceorrehabilitationprogramapprovedforsuch oC$ purposesbyaFederal,State,orlocalhealth,lawenforcement,orotherappropriateagency; v$v$ [HHl%P X`h!$p&( +x-/(24609;=HHl%vP X l (g)0 % Makingagoodfaithefforttocontinuetomaintainadrugfreeworkplacethroughimplementationofparagraphs(a)(b),(c),(d),(e) V' and(f). G(%$%$  B.Thegranteemayinsertinthespaceprovidedbelowthesite(sfortheperformanceofworkdoneinconnectionwiththespecificgrant: i* PlaceofPerformance(Streetaddress,city,county,state,zipcode)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Check___ifthereareworkplacesonfilethatarenotidentifiedhere.f52"`xC! `EQ%C!tt[ *%"Af HIHIH$H$ HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI H$H$HIHI  3y3CHECK򀀀IFTHISCERTIFICATIONISFORANAPPLICANTWHOISANINDIVIDUAL.  )':   #33y8# AlternateII.(GranteesWhoAreIndividuals)  *(<  l (a)0 % Thegranteecertifiesthat,asaconditionofthegrant,heorshewillnotengageintheunlawfulmanufacture,distribution,dispensing, n+B*> possession,oruseofacontrolledsubstanceinconductinganyactivitywiththegrant; %$%$  l (b)0 % Ifconvictedofacriminaldrugoffenseresultingfromaviolationoccur%  ringduringtheconductofanygrantactivity,heorshewill -U,A reporttheconviction,inwriting,within10calendardaysoftheconviction,tothegrantofficerorotherdesignee,unlesstheFederalagencydesignatesacentralpointforthereceiptofsuchnotices.Whennoticeismadetosuchacentralpoint,itshallincludetheidentificationnumber(s)ofeachaffectedgrant. /.D%$%$ -HHHHl%P X- H 33Hd,3DI2010 w0K/E  H June1995 H (ThisformreplacesDI1953,DI1954, H DI1955,DI1956andDI1963)#3,33Hd#1HHl%P XHH1  10H -i5MJ3#h L726!< `EH,6!zdtn " i , 3y3  CHECK򀀀IFCERTIFICATIONISFORTHEAWARDOFANYOFTHEFOLLOWINGAND [/ THEAMOUNTEXCEEDS$100,000:AFEDERALGRANTORCOOPERATIVEAGREEMENT;SUBCONTRACT,ORSUBGRANTUNDERTHEGRANTORCOOPERATIVEAGREEMENT.CHECK򀀀IFCERTIFICATIONISFORTHEAWARDOFAFEDERAL  LOANEXCEEDINGTHEAMOUNTOF$150,000,ORASUBGRANTORSUBCONTRACTEXCEEDING$100,000,UNDERTHELOAN.     #33y # Theundersignedcertifies,tothebestofhisorherknowledgeandbelief,that: U )  (1)0 l NoFederalappropriatedfundshavebeenpaidorwillbepaid,byoronbehalfoftheundersigned,toanypersonforinfluencingorattempting    toinfluenceanofficeroremployeeofanagency,aMemberofCongress,andofficeroremployeeofCongress,oranemployeeofaMemberofCongressinconnectionwiththeawardingofanyFederalcontract,themakingofanyFederalgrant,themakingofanyFederalloan,theenteringintoofanycooperativeagreement,andtheextension,continuation,renewal,amendment,ormodificationofanyFederalcontract,grant,loan,orcooperativeagreement. l$l$ (2)0 l IfanyfundsotherthanFederalappropriatedfundshavebeenpaidorwillbepaidtoanypersonforinfluencingorattemptingtoinfluence % anofficeroremployeeofanyagency,aMemberofCongress,anofficeroremployeeofCongress,oranemployeeofaMemberofCongressinconnectionwiththisFederalcontract,grant,loan,orcooperativeagreement,theundersignedshallcompleteandsubmitStandardFormLLL,"DisclosureFormtoReportLobbying,"inaccordancewithitsinstructions. l$l$ (3)0 l Theundersignedshallrequirethatthelanguageofthiscertificationbeincludedintheawarddocumentsforallsubawardsatalltiers(including  subcontracts,subgrants,andcontractsundergrants,loans,andcooperativeagreements)andthatallsubrecipientsshallcertifyaccordingly. l$l$ Thiscertificationisamaterialrepresentationoffactuponwhichreliancewasplacedwhenthistransactionwasmadeorenteredinto.SubmissionofthiscertificationisaprerequisiteformakingorenteringintothistransactionimposedbySection1352,title31,U.S.Code.Anypersonwhofailstofiletherequiredcertificationshallbesubjecttoacivilpenaltyofnotlessthan$10,000andnotmorethan$100,000foreachsuchfailure.Astheauthorizedcertifyingofficial,Iherebycertifythattheabovespecifiedcertificationsaretrue.򀀀 5 ) SIGNATUREOFAUTHORIZEDCERTIFYINGOFFICIAL򀀀  - TYPEDNAMEANDTITLE򀀀 #a"1 DATE  8$ #2 3y3-HHHHl%P X- H #33y3#3,Hd,3DI2010 /g.C  H June1995 H (ThisformreplacesDI1953,DI1954, H DI1955,DI1956andDI1963)#3,3,Hd#  0/F  *2 d d dd td 4td 4td td RSH$H$, dd ,td ,td ,Xtd ,td ,td ,td +  7& , x73y3Form15112 x (February1989)#33y?#@X X 3y3UnitedStatesDepartmentoftheInterior3,Hd,3yԈ : @ 3y,3,HdBureauofLandManagement3:3yԈ  @qq3  !3:AMENDMENTOFREQUESTFOR  @;;APPLICATION/MODIFICATIONOF@ASSISTANCEAGREEMENT3: !3 Ԉ ;v, 4 ;@ 3^y _3:PAGE3: _3^yԀ13^y _3:OF3: _3^yԀ3^y _3:PAGES3: _3^yԈ C9&x x  v C *vv  *3^y _3:1.AMENDMENT/MODIFICATIONNO.3: _3^y 9   Ѐ C9&   vv C *vv U  *3^y _3:2.EFFECTIVEDATE3: _3^y    Ѐ C9&\   vv C *vv Q%  *3^y _3:3.REQUISITIONNO.3: _3^y   Ѐ OvB&X,  vv >O3^y _3:4.ISSUEDBY3: _3^y }  9vv*) v 93^y _3:5.ADMINISTEREDBY(IfotherthanItem4.)3: _3^y }  SvB&)  > vv S3^y _3:6.NAMEANDADDRESSOFRECIPIENT(No.,street,county,state,andZIP)3: _3^y z N   Lvv;,P$JJv L(3) z N   Gvv8)% !vv G3^y _3:7A.AMENDMENTOFREQUESTFORAPPLICATIONNO.3: _3^y z N " Ѐ C9& #  vv tC   #  *vv  # *3^y _3:7B.DATED3: _3^yԀ C9&J $ t vv C ,vv  $ , Gvv8)o% %vv G3^y _3:8A.MODIFICATIONOFASSISTANCEAGREEMENTNO.3: _3^y o& Ѐ C9&'  vv tC  '  *vv ' *3^y _3:8B.DATED3: _3^yԀ OvB&k?( t vv PO3^y _3:9.THISITEMAPPLIESTOAMENDMENTSOFREQUESTFORAPPLICATION3: _3^yԀ OvB&) P v &OЀ33:&3Ey _3ԀTheabovenumberedRequestisamendedassetforthinItem10.ThehouranddatespecifiedforreceiptofApplications3 _3Ey&3Ey _3Ԁisextended,3 _3Ey&3Ey _3Ԁisnotextended.  * ApplicantsmustacknowledgereceiptofthisamendmentpriortothehouranddatespecifiedintheRequestorasamended,byoneofthefollowingmethods:  a)BycompletingItems6and13,andreturning򀀀copiesoftheamendment;b)ByacknowledgingreceiptofthisamendmentofeachcopyoftheApplicationsubmitted;orc)Byseparate - letterortelegramwhichincludesareferencetotheRequestforApplicationandamendmentnumbers.FAILUREORYOURACKNOWLEDGMENTTOBERECEIVEDATTHEPLACEDESIGNATEDFORTHERECEIPTOFAPPLICATIONSPRIORTOTHEHOURANDDATESPECIFIEDMAYRESULTINREJECTIONOFYOURAPPLICATION.Ifbyvirtueofthisamendmentyoudesiretochangeanapplicationalreadysubmitted,suchchangemaybemadebytelegramorletter,providedeachtelegramorlettermakesreferencetotheRequestforApplicationandthisamendment,andisreceivedpriortothehouranddatespecified. XvK/1 & v X3^y _ _3Ey10.DESCRIPTIONOFAMENDMENT/MODIFICATION(attachadditionalpagesifneeded)3: _3^y -2 3Ey _3:Exceptasprovidedherein,alltermsandconditionsofthedocumentreferencedinItem7Aor8Aabove,asheretoforechanged,remainunchangedandinfullforceandeffect. OvB&Z .= v PO3^y _ _3Ey11.ACCOUNTINGANDAPPROPRIATIONDATA(Ifrequired)3: _3^yԀ OvB&x!L > P v O3^y _3:12.IMPORTANT:Recipient3 _3^y&3^y _3Ԁisnot,3 _3^y&3^y _3Ԁisrequiredtosignthisdocumentandreturn򀀀copiestotheissuingoffice.3: _3^y OvB&"!?  v O3^y _3:13A.NAMEANDTITLEOFSIGNER(Typeorprint)3: _3^y e$9#@ Ѐ 9vv*%c$Bv 93^y _3:14A.NAMEANDTITLEOFASSISTANCEOFFICER(Typeorprint)3: _3^y e$9#C Ѐ Kvu:&%c$E  vv K3^y _3:13B.RECIPIENT/APPLICANT &%F 򀀀 '&H @W 3,Hd, _3^y(AuthorizedSignature) 4vvu#](1'Ivu 413C.DATESIGNED3:,3,Hd &%J @ 8vvu''&Lvvu 83^y _3:14B.UNITEDSTATESOFAMERICA &%M BY򀀀3: _3^y '&O @V3,Hd,3:(SignatureofAssistanceOfficer) 7vvu&](1'Pvvu 714C.DATESIGNED@ $ $) $3)'J'&R 0   vvu 3