NRCS-CPA-41_Entity_Application_for_an_ALE_Agreement_Final 3

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U.S. Department of Agriculture Natural Resources Conservation Service NRCS-CPA-41 1212016 ENTITY APPLICATION for an AGRICULTURAL LAND EASEMENT (ALE) AGREEMENT Clear Form This is an Entity Application for an Agricultural Land Easement (ALE) Agreement through the: (Select ONE) ❑ Agricultural Conservation Easement Program —Agricultural Land Easement (ACEP ALE) © Regional Conservation Partnership Program (RCPP)—ACEP-ALE Entity Name: NEST Application Number: 'orterra NW I AGENCY USE Entity Address: Application Date: orterra NW This is an Entity Application for an ALE Agreement, as established by the Agricultural Act of 2014. By signing and submitting this application, you agree to comply with the requirements of ACEP ALE. I. ❑✓ Yes ElOo Do you have entity records established with the appropriate USDA service center agency? If no, you must establish them with the appropriate USDA service center agency prior to submitting this application. 2. A Dun & Bradstreet Data Universal Numbering System (DUNS) number and current registration in the System for Award Management (SAM) is required for receiving payment under an EIN. If you do not have a DUNS number information is available at httD-1,fedaov.dnb.com/webfo►mTo register with SAM, go tohttns.-1Ayww.sam.00v/ DUNS Number: b90020616 3. ❑✓ Yes ❑ No Do you have the authority and capability to acquire, manage, and enforce agricultural land easements? 4. How many entity staff are dedicated to monitoring and easement stewardship? 5 ❑ Yes ✓❑ No Are you an NRCS Certified Entity'? 6. [2]Yes [—]No Are all parcelsll associated with this application subject to a written pending offer"A signed by the eligible entity for purchase of an agricultural land easementP' by an eligible entity j? PAGE1 of5 Entity Type: ❑ State Government ❑ Local Government Entity Email: ❑ Indian Tribe 3draper@forterra.org ©Non-governmental Organization F Entity TIN Application PPlion Total Acres: 73.6 Telephone: State: 206) 905-6956 WA Land Eligibility Category for Agreement (8elect one 15: ❑ Has prime, unique, or other productive soil ❑ Contains historical or archaeological resourcesp © Protects grazing uses and related conservation values ❑ Furthers a State or local government policy consistent with the purposes of ACEP. Cite the State or local government policy consistent with ACEP: Is this an application for a Grassland of Special Environmental Significance (GSS) ALE Agreement: ❑ Yea n N4 This is an Entity Application for an ALE Agreement, as established by the Agricultural Act of 2014. By signing and submitting this application, you agree to comply with the requirements of ACEP ALE. I. ❑✓ Yes ElOo Do you have entity records established with the appropriate USDA service center agency? If no, you must establish them with the appropriate USDA service center agency prior to submitting this application. 2. A Dun & Bradstreet Data Universal Numbering System (DUNS) number and current registration in the System for Award Management (SAM) is required for receiving payment under an EIN. If you do not have a DUNS number information is available at httD-1,fedaov.dnb.com/webfo►mTo register with SAM, go tohttns.-1Ayww.sam.00v/ DUNS Number: b90020616 3. ❑✓ Yes ❑ No Do you have the authority and capability to acquire, manage, and enforce agricultural land easements? 4. How many entity staff are dedicated to monitoring and easement stewardship? 5 ❑ Yes ✓❑ No Are you an NRCS Certified Entity'? 6. [2]Yes [—]No Are all parcelsll associated with this application subject to a written pending offer"A signed by the eligible entity for purchase of an agricultural land easementP' by an eligible entity j? PAGE1 of5