**AGREEMENTS WITH STATE, LOCAL, & TRIBAL GOVERNMENTS**

11/21/2000 Version

The following forms are completed by the applicant before the Statement
of Programmatic Involvement and Instrument Selection Determination are
completed. The SF forms and applicable OMB Circulars may be found on the
Internet at the following site:
*[http://www.whitehouse.gov/OMB/grants/index.html]{.underline}*

 SF-424, Application for Federal Assistance

 SF-424A, Budget Information - Nonconstruction Programs

 SF-424B, Assurances - Nonconstruction Programs

 DI-2010, Certification Regarding Debarment, Suspension and Other
Responsibility Matters, Drug-Free Workplace Requirements and Lobbying
(This form is located at the end of this model)

A. Information will need to be filled in that is specific to each
agreement. Some of the sections, such as Section I, II, and III, are
obvious and the others are marked with a \*. The following procedures
will help you find all the spaces that require a fill-in:

> 1\. Start with your cursor at the [beginning]{.underline} of the model
> agreement and hit the F2 (Find and Replace) key. At the bottom of the
> screen you will see the Find and Replace text box appear.
>
> 2\. In the Find box type in the \* (all the spaces to be filled are
> marked with \*).
>
> 3\. With your mouse click on Find Next and your cursor will
> automatically move to the first \*. You will need to backspace (to
> erase the \*) and type in the information for your agreement.
>
> 4\. With the mouse click on Find Next to move to the next \* and the
> next \* will appear.
>
> 5\. Keep doing this until you reach the end of the document.

B. Edit the Agreement Number in the Header. Once you have filled in the
new number, you will need to exit out of the Header by clicking on File,
Close. The first page number in \"Page \_\_\_ of \_\_\_\" in the Header
will start with Page 2. The second page number is created by a code on
the last page of the document (Target (Pages)). Do not delete this code.
This page number does not automatically change as pages are added. You
must generate the document (Control F9) in order for it to change. If
you do not generate the document before you print, WordPerfect will ask
you if you would like to \"generate\" before you print, just answer
\"Yes\".

C. \"Comments\" have been added throughout this document with helpful
information to assist you in completing the agreement easier and faster.
The comments are within an oval in the left margin and show up in full
text only when you use the mouse and click on the oval. Click on the
oval on the left of this paragraph now.

D. As you go through the document delete the paragraphs not needed.
Select one of the paragraphs if similar paragraphs are allowed.

If you have any questions, comments, or suggested changes please contact
your State Procurement Analyst or Brian Heath at (202)452-5186.

+-----------------------------+----------+------------------+----------+
| Form 1511-1                 |          | PAGE 1 OF PAGES  |          |
|                             |          |                  |          |
| (February 1989) United      |          |                  |          |
| States Department of the    |          |                  |          |
| Interior                    |          |                  |          |
|                             |          |                  |          |
| Bureau of Land Management   |          |                  |          |
|                             |          |                  |          |
| ASSISTANCE AGREEMENT        |          |                  |          |
|                             |          |                  |          |
| NOTE: By signing this       |          |                  |          |
| document, the recipient     |          |                  |          |
| accepts this agreement and  |          |                  |          |
| agrees to perform in        |          |                  |          |
| accordance with all the     |          |                  |          |
| enclosed terms, conditions, |          |                  |          |
| and documents attached      |          |                  |          |
| hereto.                     |          |                  |          |
+-----------------------------+----------+------------------+----------+
|                             |          | 1\. AGREEMENT    |          |
|                             |          | NO.              |          |
+-----------------------------+----------+------------------+----------+
|                             |          | 2\. TASK ORDER   |          |
|                             |          | NO.              |          |
+-----------------------------+----------+------------------+----------+
|                             |          | 3\. TYPE OF      |          |
|                             |          | AGREEMENT        |          |
|                             |          | *(Check one)*    |          |
|                             |          |                  |          |
|                             |          |  GRANT          |          |
|                             |          |                  |          |
|                             |          |  COOPERATIVE    |          |
|                             |          | AGREEMENT        |          |
+-----------------------------+----------+------------------+----------+
| 4\. NAME, ADDRESS AND PHONE |          | 5\. NAME,        |          |
| NO. OF ASSISTANCE OFFICER   |          | ADDRESS AND      |          |
|                             |          | PHONE NO. OF     |          |
|                             |          | RECIPIENT        |          |
+-----------------------------+----------+------------------+----------+
| 6\. NAME, ADDRESS AND PHONE |          | 7\. NAME,        |          |
| NO. OF ASSISTANCE           |          | ADDRESS AND      |          |
| REPRESENTATIVE              |          | PHONE NO. OF     |          |
|                             |          | RECIPIENT\'S     |          |
|                             |          | PROJECT MANAGER  |          |
+-----------------------------+----------+------------------+----------+
| 8\. PROGRAM STATUTORY       |          | 9\. STARTING     |          |
| AUTHORITY                   |          | DATE             |          |
+-----------------------------+----------+------------------+----------+
| 10\. EFFECTIVE DATE         |          | 11\. COMPLETION  |          |
|                             |          | DATE             |          |
+-----------------------------+----------+------------------+----------+
| 12\. TYPE OF RECIPIENT      |          | 13\. FUNDING     |          |
| *(Check one)*               |          | INFORMATION      |          |
|                             |          |                  |          |
|  STATE                     |          | Recipient BLM    |          |
|                             |          |                  |          |
|  LOCAL GOVERNMENT          |          | This obligation  |          |
|                             |          | \$ \$            |          |
|  INDIAN TRIBAL GOVERNMENT  |          |                  |          |
|                             |          | Previous         |          |
|  EDUCATIONAL INSTITUTION   |          | obligation \$ \$ |          |
|                             |          |                  |          |
|  INDIVIDUAL                |          | Total obligation |          |
|                             |          | \$ \$            |          |
|  FOR-PROFIT ORGANIZATION   |          |                  |          |
|                             |          | Share Ratio      |          |
|  NON-PROFIT ORGANIZATION   |          | [%]{.underline}  |          |
|                             |          | [%]{.underline}  |          |
|  OTHER (SPECIFY)           |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 14\. ACCOUNTING AND         |          |                  |          |
| APPROPRIATION DATA          |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 15\. PROJECT TITLE AND      |          |                  |          |
| BRIEF SUMMARY OF THE        |          |                  |          |
| PURPOSE AND OBJECTIVES      |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 16a. NAME AND TITLE OF      |          | 17a. NAME AND    |          |
| SIGNER *(Type or print)*    |          | TITLE OF         |          |
|                             |          | ASSISTANCE       |          |
|                             |          | ORDERING OFFICER |          |
|                             |          | *(Type or        |          |
|                             |          | print)*          |          |
+-----------------------------+----------+------------------+----------+
| 16b. RECIPIENT              | 16c.     | 17b. UNITED      | 17c.     |
|                             | DATE     | STATES OF        | DATE     |
| *(Authorized Signature)*    | SIGNED   | AMERICA          | SIGNED   |
|                             |          |                  |          |
|                             |          | BY               |          |
|                             |          |                  |          |
|                             |          | *(Signature of   |          |
|                             |          | Assistance       |          |
|                             |          | Officer)*        |          |
+-----------------------------+----------+------------------+----------+

I. [Statement of Joint Objectives]{.underline}

A. [Purpose]{.underline}. This agreement is made and entered into by the
Department of the Interior, Bureau of Land Management, \* State Office
(BLM), and the \* (\*), for the purpose of \*

B. [Objective]{.underline}.

C. [Authority]{.underline}. The basis for this agreement is found on
support or stimulation of a public purpose authorized by the following
Federal statue(s):

1\. Federal Land Policy and Management Act of 1976 (Public Law 94-579,
Section 307 (b)).

2\.

D. [Benefits]{.underline}. The activity to be undertaken through this
agreement are in furtherance of the BLM and the \* mission by the
providing the following benefits:

1\.

2\.

II\. [Definitions]{.underline}.

A. Agreement: This cooperative agreement.

A. Agreement: This grant agreement.

B. Assistance Officer (AO): The BLM\'s Assistance Officer. The AO is the
only individual authorized to obligate funds, award, modify or terminate
the agreement or any task order (TO) thereto. The AO is responsible for
issuing TOs, monitoring the agreement and TOs for compliance, enforcing
the agreement provisions, issuing timely performance and payment
approvals, terminating the agreement or any TO thereto and closing out
the agreement.

C. Assistance Representative (AR): The BLM\'s Assistance Representative.
The AR will be designated for the purpose of administering the technical
aspect of the agreement. The AR is authorized to clarify technical
requirements, and to review and approve work which is clearly within the
scope of the work specified in this agreement. The AR is not authorized
to issue changes or in any other way modify this agreement.

D. The Bureau of Land Management (BLM). May also be referred to as
Bureau.

E. The Code of Federal Regulations (CFR).

F. Fiscal Year (FY): The Federal fiscal year which extends from October
1 of one year through September 30 of the following year.

G. The \* (\*). May also be referred to as recipient.

H. Not-to-Exceed (NTE) Amount: The maximum Federal funding amount.

I. The Office of Management and Budget (OMB).

J. Project Inspector (PI): The BLM\'s project inspector. At the time of
award, a BLM employee(s) may be appointed as the PI. If appointed, the
PI will be responsible for providing on-site inspection of the work and
for giving the \* representative any special instructions, guidance, or
training necessary to complete or perform the work. The PI will not be
authorized to issue changes or in any way modify the agreement.

K. Project Manager: The recipient\'s Project Manager. \*

L. Responsible Official: The recipient\'s Responsible Official. The
responsible official is the individual who is authorized to act for the
recipients organization and commit the recipient to compliance with the
terms and conditions of this agreement.

M. Task Order (TO): The order which is issued against the agreement to
obligate funds for specific services or work to be accomplished.

N. Assistance Ordering Officer (AOO): The BLM\'s Assistance Ordering
Officer. The AOO is an individual authorized by the AO to issue TOs
against this agreement. The AOO is responsible for obligating the funds,
monitoring for compliance, enforcing the provisions, issuing timely
performance and payment approvals, modifying, terminating, and closing
out the TO. The AOO is not authorized to issue changes or in any other
way modify this agreement. A Project Inspector may be appointed by the
AOO for the TO.

III\. [Project Management Plan]{.underline}.

A. The \* agrees to:

1\.

2\.

3\.

B. The BLM agrees to:

1\.

2\.

3\. Provide payments to the \* in accordance with Section \*, Financial
Support, and Section \*, Payments, of this agreement and applicable OMB
and Treasury Regulations.

IV\. [Term of Agreement]{.underline}. This agreement shall become
effective on the date of signature of the BLM Assistance Officer and
shall remain in effect for the remainder of FY \*, unless terminated in
accordance with the provisions of 43 CFR Subpart C, Section 12.84. This
agreement may be renewed for subsequent FYs (NTE a total of five),
subject to the availability of Federal funding, by mutual written
modification signed by both parties to this agreement.

IV\. [Term of Agreement]{.underline}. This agreement shall become
effective on the date of signature of the BLM Assistance Officer and
shall remain in effect until \*, unless terminated in accordance with
the provisions of 43 CFR, Subpart C, Section 12.84.

V. [Task Orders (TO)]{.underline}.

A. Issuance. If any TOs are issued they will be issued in writing by the
Assistance Officer and must be signed by both the authorized responsible
official and the AO to be effective.

B. Contents. A TO will contain:

1\. The specifications or statement of work which specifies what will be
performed under this TO.

2\. A list of any deliverable items that are required.

3\. Any necessary drawings and/or location maps.

4\. The delivery schedule or completion time which has been negotiated
based on the level of difficulty, site location, etc.

5\. A detailed budget submitted on form SF-424A, Budget Information -
Nonconstruction Programs with a NTE amount for the task.

6\. Any other detail or information necessary.

VI\. [Financial Support]{.underline}.

A. This agreement shall be funded each FY based on the availability of
BLM funding. The \* hereby releases the BLM from all liability due to
failure of Congress to appropriate funds for this agreement.

A. This agreement shall be funded by issuance of TOs based on the
availability of BLM funding. The \* hereby releases the BLM from all
liability due to failure of Congress to appropriate funds for this
agreement.

B. Funds obligated but not expended in one FY can be carried forward and
expended in the subsequent FY.

B. Funds obligated for a specific TO but not expended in that FY can be
carried forward and expended in the subsequent FY.

C. \$\* represents the NTE amount for which the BLM will be responsible
under the terms of this agreement. The BLM shall not be obligated to pay
for nor shall the \* be obligated to perform any effort that will
require the expenditure of Federal funds above the NTE amount.

C. TOs will specify the NTE amounts. The BLM shall not be obligated to
pay for nor shall \* be obligated to perform any effort that will
require the expenditure of Federal funds above the NTE amount specified
in that TO.

C. \$\* represents the NTE amount for which the BLM will be responsible
under the terms of this agreement over the life of the agreement. Each
TO issued will specify the NTE amount for that TO. The BLM shall not be
obligated to pay for nor shall the \* be obligated to perform any effort
that will require the expenditure of Federal funds above the NTE amount
specified in that TO.

D. Cost sharing for this agreement shall be in accordance with 43 CFR,
Subpart C, Section 12.64.

E. Program income for this agreement shall be in accordance with 43 CFR,
Subpart C, Section 12.65.

VII\. [Payments]{.underline}.

A. Electronic Funds Transfer Payments

1\. Payment under this agreement will be made by the Government by
electronic funds transfer (through the Treasury Fedline Payment System
(FEDLINE) or the Automated Clearing House (ACH)).

2\. After award, but no later than 14 days before an invoice or
agreement financing request is submitted, the Recipient shall designate
a financial institution for receipt of electronic funds transfer
payments (SF-3881), and shall submit this designation to the following
address:

Bureau of Land Management

National Business Center, BC-630

Denver Federal Center, Bldg. 50

PO Box 25047

Denver, CO 80225-0047

3\. If a designation has been submitted to the BLM under a previous
agreement it is not necessary to complete another SF-3881 unless you are
changing your designation of financial institution.

B. The \* shall be entitled to reimbursement\* or advance payment\* at
least quarterly upon submission of an original Request for Advance or
Reimbursement, Standard Form (SF) 270 to the AR. Payments shall be
governed by the provisions of 43 CFR Subpart C, Section 12.61 and 12.81.

C. If advance payments are made the \* must submit a Federal Cash
Transaction Report, SF 272 to the Assistance Officer 15 working days
following the end of each quarter.

D. Advance payments shall be made only in amounts necessary to meet
current disbursement needs and shall be scheduled so that the funds are
available only immediately prior to their disbursement.

VIII\. [Property Management and Disposition]{.underline}.

Any BLM property used or other property acquired under this agreement,
including intangible property such as copyrights and patents shall be
governed by the provisions of 43 CFR, Subpart C, Section 12.71 through
12.74.

IX\. [Deliverables and Reports]{.underline}.

Submit one copy of an annual performance report to the Assistance
Representative within 90 days after the end of the FY. The performance
report must be prepared in accordance with 43 CFR, Subpart C, Section
12.80 and address items such as a comparison of actual accomplishments
with established goals, reasons why goals may not have been met, cost
overruns and any other pertinent information.

X. [Key Officials]{.underline}.

A. Assistance Officer (AO)

\*

Bureau of Land Management

\* State Office

P.O. Box \*

\*

Telephone Number (\*) \*

B. Assistance Representative (AR)

\*

Bureau of Land Management

\* State Office

P.O. Box \*

\*

Telephone Number (\*) \*

C. Project Inspector (PI)

\*

Bureau of Land Management

\* State Office

P.O. Box \*

\*

Telephone Number (\*) \*

D. Responsible Official

\*(Name)

\*(Recipients name and address

\*

\*

Telephone Number (\*) \*

E. Project Manager

\*(Name)

\*(Recipients name and address

\*

\*

Telephone Number (\*) \*

XI\. [Special Terms and Conditions]{.underline}.

A. Order of Precedence

Any inconsistency in this agreement shall be resolved by giving
precedence in the following order: (a) Any national policy requirements
and administrative management standards; (b) requirements of the
applicable OMB Circulars and Treasury regulations; (c) 43 CFR Part 12;
(d) special terms and conditions; and (e) all Agreement sections,
documents, exhibits, and attachments.

A. Order of Precedence

Any inconsistency in this agreement shall be resolved by giving
precedence in the following order: (a) Any national policy requirements
and administrative management standards; (b) requirements of the
applicable OMB Circulars and Treasury regulations; (c) 43 CFR Part 12;
(d) special terms and conditions; (e) all Agreement sections, documents,
exhibits, and attachments; and (f) all TO sections, documents, exhibits,
and attachments.

B. Modifications

This agreement may be modified by written agreement signed by both a \*
official and the Assistance Officer. Administrative changes (i.e. AO
name change) which do not change the project management plan, NTE
amount, etc. or otherwise affect the recipient may be signed
unilaterally by the AO.

C. Procurement Procedures

It is a national policy to place a fair share of purchases with minority
business firms. The Department of the Interior is strongly committed to
the objectives of this policy and encourages all recipients of its
grants and cooperative agreements to take affirmative steps to ensure
such fairness. Positive efforts shall be made by recipients to utilize
small businesses, minority-owned firms, and women\'s business
enterprises, whenever possible. Recipients of Federal awards shall take
all of the following steps to further this goal:

1\. Ensure that small businesses, minority-owned firms, and women\'s
business enterprises are used to the fullest extent practicable.

2\. Make information on forthcoming opportunities available and arrange
time frames for purchases and contracts to encourage and facilitate
participation by small businesses, minority-owned firms, and women\'s
business enterprises.

3\. Consider in the contract process whether firms competing for larger
contracts intend to subcontract with small businesses, minority-owned
firms, and women\'s business enterprises.

4\. Encourage contracting with consortiums of small businesses,
minority-owned firms and women\'s business enterprises when a contract
is too large for one of these firms to handle individually.

5\. Use the services and assistance, as appropriate, of such
organizations as the Small Business Development Agency in the
solicitation and utilization of small business, minority-owned firms and
women\'s business enterprises.

D. Deposit of Publications

Two (2) copies of each applicable publication produced under this
agreement shall be sent to the Natural Resources Library with a
transmittal that identifies the sender and the publication, and states
that the publication is intended for deposit in the Natural Resources
Library. Publications shall be sent to the following address:

U.S. Department of the Interior

Natural Resources Library

Interior Service Center

Gifts and Exchanges Section

1849 C Street, N.W.

Washington, D.C. 20240

XII\. [General Provisions]{.underline}.

A. National Policy Requirements and Administrative Management Standards.
All applicable national policy requirements and administrative
management standards as set forth in the Office of Management and
Budget, Financial Management Division, Directory of Policy Requirements
and Administrative Standards for Federal Aid Programs are incorporated
by reference.

B. 43 CFR Part 12, Administrative and Audit Requirements and Cost
Principles for Assistance Programs is incorporated by reference.

C. OMB Circular A-87, Cost Principles for State and Local Governments is
incorporated by reference.

D. Single Audit Act Amendments of 1996, Public Law 104-156, 110 Stat.
1396, 31 U.S.C. 750 1-7 and 43 CFR, Part 12, is incorporated by
reference.

E. 43 Code of Federal Regulations (CFR) Part 12, Appendix A to Subpart
D, Certification Regarding Debarment, Suspension, and Other
Responsibility Matters - Primary Covered Transaction and completed Form
DI-2010 are incorporated by reference.

F. 43 CFR Part 12, Appendix C to Subpart D, Certification Regarding
Drug-Free Workplace Requirements, Alternate I (Grantees other than
individuals) and completed Form DI-2010 are incorporated by reference.

G. 3l U.S.C. 1352, Certification Regarding Lobbying and completed Form
DI-2010 are incorporated by reference.

H. Single Audit Act Amendments of 1996, Public Law 104-156, 110 Stat.
1396, 31 U.S.C. 750 1-7 and 43 CFR, Part 12, is incorporated by
reference.

I. Compliance With Buy American Act. Pursuant to Sec. 307 of the
Department of the Interior and Related Agencies Appropriations Act of
2000, Public Law 106-113, be advised of the following:

1\. None of the funds made available in this agreement may be expended
by a recipient unless the recipient agrees that in expending the funds
the recipient will comply with sections 2 through 4 of the Act of March
3, 1933 (41 U.S.C. 10a-10c; popularly known as the \"Buy American
Act\").

2\. Purchase of American-made equipment and products. In the case of any
equipment or product that may be authorized to be purchased with
financial assistance provided using funds made available in this Act, it
is the sense of the Congress that entities receiving the assistance
should, in expending the assistance, purchase only American-made
equipment and products.

3\. Recipient also agrees to follow the procedures in 43 CFR Part 12,
Subpart E, Section 12.700 - Buy American Requirements for Assistance
Programs.

J. Opposition to Any Legislation. Recipient shall not use any part of
the Government's funds for any activity or the publication or
distribution of literature that in any way tends to promote public
support or opposition to any legislative proposal on which Congressional
action is not complete.

K. Increasing Seat Belt Use in the United States. Recipients of
grants/cooperative agreements and/or sub-awards are encouraged to adopt
and enforce on-the-job seat belt use policies and programs for their
employees when operating company-owned, rented, or personally owned
vehicles. These measures include, but are not limited to, conducting
education, awareness, and other appropriate programs for their employees
about the importance of wearing seat belts and the consequences of not
wearing them.

**U.S. Department of the Interior**

**Certifications Regarding Debarment, Suspension and**

**Other Responsibility Matters, Drug-Free Workplace**

**Requirements and Lobbying**

Persons signing this form should refer to the regulations referenced
below for complete instructions:

Certification Regarding Debarment, Suspension, and Other Responsibility
Matters - Primary Covered Transactions - **The prospective primary
participant further agrees by submitting this proposal that it will
include the clause titled, \"Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transaction,\" provided by the department or agency entering into this
covered transaction, without modification, in all lower tier covered
transactions and in all solicitations for lower tier covered
transactions.** See below for language to be used or use this form for
certification and sign. (See Appendix A of Subpart D of 43 CFR Part 12.)

Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion - Lower Tier Covered Transactions - (See Appendix B
of Subpart D of 43 CFR Part 12.)

Certification Regarding Drug-Free Workplace Requirements - Alternate I.
(Grantees Other Than Individuals) and Alternate II. (Grantees Who are
Individuals) - (See Appendix C of Subpart D of 43 CFR Part 12)

Signature on this form provides for compliance with certification
requirements under 43 CFR Parts 12 and 18. The certifications shall be
treated as a material representation of fact upon which reliance will be
placed when the Department of the Interior determines to award the
covered transaction, grant, cooperative agreement or loan.