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U.S. Department of Agriculture <br />Natural Resources Conservation Service <br />NRCS-CPA-41 <br />12/2016 <br />ENTITY APPLICATION for an AGRICULTURAL LAND EASEMENT (ALE) AGREEMENT <br />Clear Form <br />This is an Entity Application for an Agricultural Land Easement (ALE) Agreement through the: (select ONE) <br />❑ Agricultural Conservation Easement Program —Agricultural Land Easement (ACEP-ALE) <br />❑D Regional Conservation Partnership Program (RCPP) — ACEP-ALE <br />Entity Name: NEST Application Number: <br />Forterra NW AGENCY USE <br />Entity Address: <br />Forterra NW <br />Entity Email: <br />adraper@forterra.org <br />Entity TIN <br />94-3112461 <br />Telephone: <br />(206) 905-6956 <br />Land Eligibility Category for Agreement (Select OneF): <br />❑ Has prime, unique, or other productive soil <br />❑ Contains historical or archaeological resources <br />© Protects grazing uses and related conservation values <br />❑ Furthers a State or local government policy consistent with the purposes of ACEP <br />with ACEP: <br />Application Date: <br />Entity Type: <br />❑ State Government <br />❑ Local Government <br />❑ Indian Tribe <br />© Non-governmental Organization F <br />Application Total Acres: <br />273.6 <br />_.State: <br />A <br />Cite the State or local government policy consistent <br />Is this an application for a Grassland of Special Environmental Significance (GSS) ALE Agreement: ❑ Yes ❑J No <br />This is an Entity Application for an ALE Agreement, as established by the Agricultural Act of 2014. <br />By signing and submitting this application, you agree to comply with the requirements of ACEP-ALE. <br />1. ❑✓ Yes [:]Vo Do you have entity records established with the appropriate USDA service <br />center agency? <br />!f no, you must establish them with the appropriate USDA service center agency prior to submitting this <br />application. <br />2. A Dun & Bradstreet Data Universal Numbering System (DUNS) number and current registration <br />in the System for Award Management (SAM) is required for receiving payment under an EIN. <br />if you do not have a DUNS number information is available at <br />htt //fedvov.dnb. comAvebform To register with SAM, go to htt, s://www.sam_. gov/ <br />DUNS Number: 90020616 ` ` <br />3. 91 Yes F1 No Do you have the authority and capability to acquire, manage, and enforce <br />agricultural land easements? <br />4. How many entity staff are dedicated to monitoring and easement stewardship?; - <br />5 ❑ Yes ❑✓ No Are you an NRCS Certified Entityl°? <br />6. ❑ Yes ❑ No Are all parcelsR associated with this application subject to a written pending <br />offerv1 signed by the eligible entity for purchase of an agricultural land easementR" by an eligible <br />entit§? <br />PAGE 1 of 5 <br />