**BLM TASK ORDER MODEL FOR COLORADO PLATEAU**

**COOPERATIVE ECOSYSTEM STUDIES UNIT (CESU)**

**TASK ORDERS WITH INSTITUTIONS OF HIGHER EDUCATION,**

**HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS**

5/03/2001 Version

**CESU Partner is responsible for submitting to the BLM Project
Inspector (PI) the following proposal package:**

Colorado Plateau CESU Template and Project Proposal Package

SF-424, Application for Federal Assistance

SF-424A, Budget Information - Nonconstruction Programs

SF-424B, Assurances - Nonconstruction Programs

**BLM Project Inspector is responsible for submitting the following
package to A. J. Martinez, Assistance Representative (AR), Bureau of
Land Management**, **Utah State Office, P.O. Box 45155, Salt Lake City,
UT 84145-0155, Telephone: 801-539-4018. The information can also be
forwarded by e-mail to A.\_J.\_Martinez@ut.blm.gov with the BLM Form
1510-18 to follow.**

-   Approved Form 1510-18, Purchase Requisition/Oral Order

-   Colorado Plateau CESU Template and Project Proposal Package received
    from the host or partner

-   Application Forms received from the host or partner

-   BLM Model CESU Task Order with Section I, II, III and X completed

**The SF forms and applicable OMB Circulars may be found on the Internet
at:** *[http://www.whitehouse.gov/OMB/grants/index.html]{.underline}*

A. Information will need to be filled in that is specific to each task
order. 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
> task order 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 CESU Partner 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 task order 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
Maria Gochis your Assistance Officer 801-539-4178 or Ray Holmes, Utah
State Procurement Analyst 801-539-4172.

+-----------------------------+----------+------------------+----------+
| 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            |          |
|                             |          |                  |          |
|                             |          | X COOPERATIVE    |          |
|                             |          | AGREEMENT        |          |
+-----------------------------+----------+------------------+----------+
| 4\. NAME, ADDRESS AND PHONE |          | 5\. NAME,        |          |
| NO. OF ASSISTANCE OFFICER   |          | ADDRESS AND      |          |
|                             |          | PHONE NO. OF     |          |
| Maria Gochis                |          | RECIPIENT        |          |
|                             |          |                  |          |
| Bureau of Land Management   |          |                  |          |
|                             |          |                  |          |
| Utah State Office           |          |                  |          |
|                             |          |                  |          |
| 324 South State Street,     |          |                  |          |
| Suite 301                   |          |                  |          |
|                             |          |                  |          |
| Salt Lake City, UT          |          |                  |          |
| 84145-0155                  |          |                  |          |
|                             |          |                  |          |
| 801-539-4178                |          |                  |          |
|                             |          |                  |          |
| [Maria_                     |          |                  |          |
| Gochis@blm.gov]{.underline} |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 6\. NAME, ADDRESS AND PHONE |          | 7\. NAME,        |          |
| NO. OF ASSISTANCE           |          | ADDRESS AND      |          |
| REPRESENTATIVE              |          | PHONE NO. OF     |          |
|                             |          | RECIPIENT\'S     |          |
| A.J. Martinez               |          | PROJECT MANAGER  |          |
|                             |          |                  |          |
| Bureau of Land Management   |          |                  |          |
|                             |          |                  |          |
| Utah State Office           |          |                  |          |
|                             |          |                  |          |
| 324 South State Street      |          |                  |          |
|                             |          |                  |          |
| Salt Lake City, UT          |          |                  |          |
| 84145-0155                  |          |                  |          |
|                             |          |                  |          |
| 801-539-4018                |          |                  |          |
|                             |          |                  |          |
| [A.\_J.\_Ma                 |          |                  |          |
| rtinez@blm.gov]{.underline} |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 8\. PROGRAM STATUTORY       |          | 9\. STARTING     |          |
| AUTHORITY                   |          | DATE             |          |
|                             |          |                  |          |
| FLPMA of 1976, Section 307  |          |                  |          |
| (b)                         |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 10\. EFFECTIVE DATE Date of |          | 11\. COMPLETION  |          |
| Signature of A.O.           |          | 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      |          |                  |          |
|                             |          |                  |          |
| Cooperative Agreement       |          |                  |          |
| No.\*, Task Order No. \*,   |          |                  |          |
| \* Proposal, SF-424         |          |                  |          |
| Application for Federal     |          |                  |          |
| Assistance, SF-424A Budget  |          |                  |          |
| Information, dated \* is    |          |                  |          |
| being awarded under the     |          |                  |          |
| Master Colorado Plateau     |          |                  |          |
| Cooperative Ecosystem       |          |                  |          |
| Studies Unit, (CPCESU)      |          |                  |          |
| Cooperative Agreement No.   |          |                  |          |
| JSA990018, dated 06/09/99   |          |                  |          |
| which is incorporated       |          |                  |          |
| herein. All terms and       |          |                  |          |
| conditions of the Master    |          |                  |          |
| CPCESU Agreement will       |          |                  |          |
| remain the same.            |          |                  |          |
+-----------------------------+----------+------------------+----------+
| 16a. NAME AND TITLE OF      |          | 17a. NAME AND    |          |
| SIGNER *(Type or print)*    |          | TITLE OF         |          |
|                             |          | ASSISTANCE       |          |
|                             |          | ORDERING OFFICER |          |
|                             |          | *(Type or        |          |
|                             |          | print)*          |          |
|                             |          |                  |          |
|                             |          | Maria Gochis,    |          |
|                             |          | Assistance       |          |
|                             |          | Officer          |          |
+-----------------------------+----------+------------------+----------+
| 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 task order 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}. Authority for BLM to enter into this task
> order is contained in Federal Land Policy and Management Act of 1976
> (Public Law 94-579, Section 307 (b)).
>
> D. [Benefits]{.underline}. The activity to be undertaken through this
> task order are in furtherance of the BLM and the \* mission by the
> providing the following benefits:
>
> 1\.
>
> 2\.
>
> II\. [Definitions]{.underline}.
>
> A. Agreement: The Master Colorado Plateau Cooperative Ecosystem
> Studies Unit (CPCESU) Agreement.
>
> B. Task Order (TO): This Task Order which is issued under the Master
> CPCESU Agreement No. JSA990018 to obligate funds for specific services
> or work to be accomplished.
>
> C. 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 monitoring the Master CPCESU Agreement No. JSA990018
> 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.
>
> D. Assistance Representative (AR): The BLM\'s Assistance
> Representative. The AR will be designated for the purpose of
> administering the technical aspect of the Master CPCESU Agreement No.
> JSA990018 and TOs. 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 task order. The AR is not
> authorized to issue changes or in any other way modify the Master
> CPCESU Agreement and TO .
>
> E. The Bureau of Land Management (BLM). May also be referred to as
> Bureau.
>
> F. The Code of Federal Regulations (CFR).
>
> G. Fiscal Year (FY): The Federal fiscal year which extends from
> October 1 of one year through September 30 of the following year.
>
> H. The \* (\*). May also be referred to as recipient.
>
> I. Not-to-Exceed (NTE) Amount: The maximum Federal funding amount.
>
> J. The Office of Management and Budget (OMB).
>
> K. 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
> task order.
>
> L. Project Manager: The recipient\'s Project Manager. \*
>
> M. 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 task order.
>
> III\. [Project Management Plan]{.underline}.
>
> A. The \* agrees to:
>
> 1\. Complete the project as proposed in the recipient CPCESU Template
> and \* Project Proposal Package, dated \*, which is incorporated
> herein see attachment A.
>
> 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 task order and
> applicable OMB and Treasury Regulations.
>
> IV\. [Term of Task Order]{.underline}. This task order 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 F, Section 12.961.
> This task order 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 task order.
>
> IV\. [Term of Task Order]{.underline}. This task order 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 F, Section 12.961.
>
> V. [Financial Support]{.underline}.
>
> A. This task order 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 task order.
>
> B. Funds obligated but not expended in one 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 task order. 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.
>
> D. Cost sharing for this task order shall be in accordance with 43
> CFR, Subpart F, Section 12.923.
>
> E. Program income for this task order shall be in accordance with 43
> CFR, Subpart F, Section 12.924.
>
> VII\. [Payments]{.underline}.
>
> A. Electronic Funds Transfer Payments
>
> 1\. Payment under this task order 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 task
> order 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 AO. Payments shall be
governed by the provisions of 43 CFR Subpart F, Section 12.922 and
12.952.

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 task order,
including intangible property such as copyrights and patents shall be
governed by the provisions of 43 CFR, Subpart F, Section 12.930 through
12.937.

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 F, Section
12.951 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)

Maria Gochis

Bureau of Land Management

Utah State Office

P.O. Box 45155

Salt Lake City, UT 84145-0155

Telephone Number (801) 539-4178

[Maria_Gochis@blm.gov]{.underline}

B. Assistance Representative (AR)

A. J. Martinez

Bureau of Land Management

Utah State Office

P.O. Box 45155

Salt Lake City, UT 84145-0155

Telephone Number (801) 539-4178

[A.\_J.\_Martinez@blm.gov]{.underline}

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 TO 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) the
Master CPCESU Agreement; (e) special terms and conditions; (f) all TO
sections, documents, exhibits, and attachments, and (g) recipients
CPCESU Template and Project Proposal Package.

B. Modifications

This task order 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 task
order 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-21, Cost Principles for Educational Institutions and
the completed Certificate For Indirect Cost is incorporated by
reference.

C. OMB Circular A-122, Cost Principles for Nonprofit Organizations is
incorporated by reference.

C. Federal Acquisition Regulation (FAR) at 48 CFR Part 31 is
incorporated by reference.

C. 45 CFR Part 74, Appendix E, Principles for Determining Costs
Applicable to Research and Development Under Grants and Contracts with
Hospitals, is incorporated by reference.

D. 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.

E. 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.

F. 43 CFR Part 12, Appendix C to Subpart D, Certification Regarding
Drug-Free Workplace Requirements, Alternate II (Grantees Who are
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 task order 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. Endorsements. Recipient shall not publicize or otherwise circulate,
promotional material (such as advertisements, sales brochures, press
releases, speeches, still and motion pictures, articles, manuscripts or
other publications) which states or implies governmental, Departmental,
bureau, or government employee endorsement of a product, service, or
position which the recipient represents. No release of information
relating to this award may state or imply that the Government approves
of the recipient's work products, or considers the recipient's work
product to be superior to other products or services.

All information submitted for publication or other public releases of
information regarding this project shall carry the following disclaimer:

> The views and conclusions contained in this document are those of the
> authors and should not be interpreted as representing the opinions or
> policies of the U.S. Government. Mention of trade names or commercial
> products does not constitute their endorsement by the U.S. Government.

Recipient must obtain prior Government approval for any public
information releases concerning this award which refer to the Department
of the Interior or any bureau or employee (by name or title). The
specific text, layout photographs, etc. of the proposed release must be
submitted with the request for approval.

A recipient further agrees to include this provision in a subaward to
and subrecipient, except for a subaward to a State government, a local
government, or to a federally recognized Indian tribal Government.

L. 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.