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U.S. Department of Agriculture Natural Resources COflllervallon SeNlce Entity Role (identify either): -Holder or co-holder(#2 above), Entity Name: -Co-holder (#7 above), or -Holder of Interest (#8 above) Forterra NW Co-holder WA-RCO Holder of Interest IKlttltas County Co-holder B1. Estlmatad Individual Entity Non.federal Cash Contribution to all ALEs (total must equal item B above) 0.00 1937,500.00 0.00 NRC$-CPM1 12/2016 C1. lndlvldual Entity portion of requested Federal Share for AL.Es (total must aqua! item C above) 937,500.00 0.00 0.00 The Entity has reviewed the template Agricultural Land Easement(ALE) Agreement that stipulates the terms and conditions under which the entity would be pellTlltted to use the cos:t-share assistance applied for herein. The Entity agrees to participate in the Agricultural Land Easement component of th e Agricultural Conservation Easement Program (ACEP) If NRCS ar,d the Entity enter Into an ALE-Agreement. However, nothing in thla applloation obligates the United States or the Entity to purchase all or any of the Agricultural Land Easements listed on the Parcel Sheets attached to this application . To Identify future roles should this applieation be funded , tie undersigned Entity shall hereafter be referred to as the "Participant." The Parti cipant und erstands that unless an Entity is certified by NRCS, acquiring an Agr icultural Land Easement without the NRCS r&qulred minimum deed terms and conditions or prior to NRCS approval of the appraisal or easement valuation detennination Md title causes the Agricultural Land Easement to be ineliglble for ACEP cost-share assistance. An Entity may only be certified by the Chief of NRCS. The Participant certifies that highly erodible land conservatlontwetland conservation, adjusted gross Income certifications , and membe r' Information for an Landowners are on file with the appropriate USDA service center agency and are up to date . It is the responsibility of the Participant to provide accurate data to support all items addressed in this application at the request of NRCS. Participants acknowledge that NRCS is relying upon the veracity of the information submitted for purposes of awarding Feder1:1I funds and that the aubmittal offelse Information may be subject to criminal or civil fraud statutes. The Participant is required to be registered In the System fo r Award Management (SAM) before submitting this application and must provide a valid DUNS number on this application. l:ach Participant must continue to maintain an active SAM registration with cunant information at all times during which It has an active application for funding under consideration and at all times for the duration of any ALE-agreement entered into under the program. NRCS may not enter into an ALE-Agreement with an Entity until all applicable DUNS and SAM requirements have been met. If an Entity has not fully complied with these requirements by the time NRCS is ready to sward the PlE-Agreement, NRCS may determine that the EntitY la n.ot qualified to n,celve an ALE-Agreement and use that determination aa a basis for making an award to another appicant. lnftlal 13.1 ✓ l-1 certify that the Entity has Its own cah resources to provide the Total Estimated Entity Non-Federal Cash Contribution stated In 11.B. above. 14. f ✓ 1-Non-certJfled entltlN: I have received and reviewed a copy of the required ALE-Cooperative Agreement Template and United States Secretary of Agriculture's required minimum dead tem,s and conditions for an Agrlcultural Land Easement. 16. n -Certified entitles: I have received and reviewed a copy of the ,equlred ALE-Grant Agreement lor'1 certffled entitles which includes the United States Secretary of Agriculture's ragulato,y deed requirements that must be addrus In the Agricultural Land Easement Deed. Ism= PAGE3of5