Non-Federal Agency 

Pollution Removal Funding Authorization 

Page 1 of 2

Recipient Agency 

Address 

Agency DUNS 

Agency Tax ID 

1. Purpose

This document authorizes reimbursement to the Recipient Agency from the Oil Spill Liability

Trust Fund or CERCLA funds for certain removal costs incurred in response to the following

pollution incident,__________________________________________________________,

Federal Project Number/CERCLA Project Number, ______________________________. 

This funding authorization is expressly contingent on the Recipient Agency’s compliance with

all requirements contained herein.

2. Approved Functions and Reimbursement Limit

Costs will be reimbursed only for actions that are directed or approved in advance by the FOSC.

Approval may be verbal or written. Assessment, restoration, rehabilitation or replacement of

natural resources damaged by the spill are not covered.

Maximum limit of authorization: $ __________________

3. Conditions

See attached page(s) for scope of work, special conditions, date of performance,

directions or approvals.

4. Period of Authorization

This authorization shall remain in effect until the completion date specified by the FOSC

(which normally corresponds to the date of final removal activities).

5. Reimbursement Procedure

Upon completion of removal activities, the Recipient Agency will submit a SF-1080/1081 to the

FOSC with detailed records of expenditures and activities for which reimbursement is sought. The

agency may elect to use its own records providing an equivalent amount of documentation which

has NPFC approval, or the agency may elect to use NPFC's Resource Cost Documentation

package. The agency must submit the final request for reimbursement, supported by the required

documentation, within 90 days following the completion date. If OMB Circular A-87 cost rates

apply, cost certifications must be included. If at the end of the 90 days from final removal activities,

there are any costs for which reimbursement has not been requested, written notice will be sent to

the agency and 30 days later any balance remaining in the account will be deobligated.

6. Hold Harmless and Indemnify

By performing any action or seeking any reimbursement under this funding authorization, the 

Recipient Agency agrees that the United States of America and all of its departments and

Rev. 03/22
Non-Federal Agency 

Pollution Removal Funding Authorization 

Page 2 of 2

agencies, including, but not limited to, the U.S. Coast Guard and the Oil Spill Liability Trust Fund 

("United States"), shall not be liable to any party for damage, injury or loss to persons or 

property resulting from the acts or omissions of Recipient Agency, its employees, agents or 

contractors, related to the Recipient Agency's performance of this Agreement. The Recipient 

agency agrees to indemnify and hold harmless the United States from all actions, claims or suits 

for damage, injury or loss to persons or property resulting from the acts or omissions of 

Recipient Agency, its employees, agents or contractors related to Recipient Agency's 

performance of this Agreement. This agreement to hold harmless and indemnify the United 

States is subject to the availability of Recipient Agency funds. The Recipient agrees in good faith 

to use available Agency funds and to undertake all reasonable effort to acquire such funds if not 

otherwise available. 

7. No Agency 

Nothing in this funding authorization is intended to create an agency relationship between the

Recipient Agency and the United States of America (or any of its departments, agencies, or

employees). Nor shall anything in this funding authorization be construed as creating an

agency relationship. By performing any action or seeking any reimbursement under this

funding authorization, the Recipient Agency agrees that it has not been authorized to act as an

agent of the United States, and shall not act in any such capacity.

8. Accounting Data

7. Points of Contact

Federal On-Scene Coordinator

Telephone: 

FAX: 

E-mail:

Recipient Agency Representative Telephone: 

FAX: 

E-Mail:

NPFC Case Officer Telephone: 

FAX: 

E-Mail:

8. Authorizing Official

Federal On-Scene Coordinator

Signature: Date 

Attachments: (1) Scope of Work 

Project: Organization: 

Expenditure Type: 252046 Task: 

Award Number: 

Rev. 03/22