HomeMy WebLinkAboutALE AgreementU.S. Department of AQrlculbn
Natural Resources Conservation Senllce
NRCS-CPA-41
12/2018
ENTITY APPLICATION for an AGRICULTURAL LAND EASEMENT (ALE) AGREEMENT
I Cl ear Form
Thia II an Entity Application for an Aa,lcultunal Land Eaaelllllllt (ALE) AgrMIMllt throuth the: (Select OIE}
D Aglfcultunal Conurvatton Enement Program -Agricultural Land EMement (ACEP-ALE)
IZ) Raglonal Conservatton Partne111hlp Program (RCPP) -ACEP-ALE
Entity Name: NEST Appllcatlon Number:
Forterre NW AGENCY USE
Entity Add ,_..:
Forterra NW
AppllallOn Date:
Entity Type: • State Govemnant
D Local GcMrnment
0 lndlan Tribe
EnlltyEmalt IZI Non-gal,wnmental Organtzallon ~
adraper@forterra .org
En:.r:TlN Application Total AcNIII:
~4-3 12461 273.6
T11lerone~ stat.:
(206 905-6956 WA
Land lllglbUlly Category for Ag ,_,.lllt (a.i.c:t Onti'):
D Hu prime, unique, or olhet proclucllve 1011
D Contains Nstorlcal or archaeological resourcas I'
IZI Protecta grazing uses and rellflld c:onaervatlon values
D Furthara a state or looal government pollcy oon1lstant wlh Iha purposes of ACEP. Clla the state or local gowamment poBcy conalltent
wtth ACEP :
la thla a n appllcallon for • Gru•land of 8,-c:lal EnYlronmantal 81gnlflcllna (GSB) ALE AglNment: 0 Y• @No
This Is an Entity Appllcatlon for an ALE Agnteme11t, as establlahed by the Agrlcultural Act of 2014.
By signing and submitting this appllcatlon, you agree to comply with the requirement& of ACEP-ALE.
1. @ Y• [)o Do you have entity records Ntabllshad with Ille appropriate USDA service
center agency? ·
If no, }'OCI must establish them with the appropriate USDA service center agency prior to submitting this
appllcstion.
2. A Dun & Bradetreet Data Unlven,1I Numbering Sys tem (DUNS) number and currant registration
In the System for Award Manag ement (SAM) Is required for recehrlng payment under an EIN.
If yau do not have 8 DUNS number Information is available at
hlfp:llfsdgov. dnb. comAvebfonn To register with SAM, go to hltDs:ltwww.sam.gov/
DUNS Number: pooo2oe16 I
3. (21 Y• D No Do you have the authority and capablllty to acquire, manage. and enforce
agricultural land easements?
4. How many entity staff ant dedicated to monitoring and e•ament stewardshlp?p._ ______ _
6 0 Ya @ No Are you an NRCS Certified Entity~?
6. 0 Y D No Are all parce P anoclamd with thfa appllcaQon subject to a written pending
offe,vi signed by the &llglblo ntlty for pwchu of an a gricultural land eaa&mentfll1 l)y an ellglble
entltf?
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U.S. Department of Agr1cult\n
Nall.Ira! RIIIOUl'C8I ConNrVatlon 8eMC&
NRCS-CPM1
12/2018
7. IZI Yes D No WIii ny other ent ity co-hold an agricultural tand easement on one or more of
the p aroe la assocfated with this applica tion?
If the answer Is Yes, then the intended co-holders must co-sign this application for an Agrfcuttural
Land Easement A ree man t ro vide a DUNS number, and be re gistered with SAM.
Name: ·tas County Tax Number: p1-6001349 j DUNS Number: p1-020-2547
Co-Holder Signature: [ I
Name,! c4"?3
1
1 DUNSNumbor: ._I ____ __.
Co-Holder Signature: 1 ... _~-----~----------
8. @ Yes D No WIii another entity, other than the Untted Stain, hold • third-party right,
contingent right, or any other real property Interest In an agricultural land easement on one or
mo,. of the parcels anoclated with lhl• appl!Qtlon, excluding entitles c<M1lgnf ng thfa
application u a co-holder?
If the answer is Y~. list th& N8m98 and Tax Identification Number for all other intended holders of
interests In the agriculture/ land easement.
Name: f#A State RCO JTu: Number: e 1-0780046 ! DUNS Number:PB-8405852
Name: I !Tax Number. I._ _____ _.! DUNS Number: l.._ _____ _
Name:),._ _____ __,!Tax Number: I._ _____ _.! DUNS Number: ... I _____ _,
9. The land otraredflN under this application II (check all that apply):
12) Prtvate Land
D Tribal, Allotted, Ceded, or lndlan Land
10. How many parcels.,. mocJated with this appllcatlon: P ... e _______ ~
You must complete an ACEP-ALE Parcel Sheet NRCS-CPA-41A for each parcel associated with
this application and attach It to this Entity Appf/caoon for an ALE A(Jl88ment.
11. Complete the below tabla with the sum totals for all parcels uaoclated with tide
application. Thflse values may be estimates, subject to the final values beinr, determined by an
NRCS-approved appraisal report or easemflfll valuation rm,thodology.
A. Tota l Ea11mated Fair Mari<.et Value of all ALEs $1,875,000
B. Total Es ti mated Entity Non-Federa l Cash Contrlbu t!cn to all ~37,500.00
ALEs {excluding Landowner donation)
C. Tota l Req uested Fede ral Share for ALEs $937,500.00
D. Total Es ti mated PL!rchesa Price'" of ALEs (D = B + C) $1 ,876,000.00
E. Total Esti mated Landowner Donation for all ALEsf (E = A -D) $0.00
12. All entffln that wlll be Identified u either a holder, co-holder, or other holder of Interest on any
agricultural land easement deed uaoclated wtth thl9 appHcatJon must be Hated on the table
below. For thoee that wlll contribute caah or realve ALE funda, Identify on the table below the
N11mated entity non-Federal cash contrtbutton (Item B above) and the requNted Federal 1hare
(Item C above) by lndlvldual entity.
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U.S. Department of Agriculture
Natural Resources COflllervallon SeNlce
Entity Role (identify either):
-Holder or co-holder(#2 above), Entity Name: -Co-holder (#7 above), or
-Holder of Interest (#8 above)
Forterra NW Co-holder
WA-RCO Holder of Interest
IKlttltas County Co-holder
B1. Estlmatad Individual
Entity Non.federal Cash
Contribution to all ALEs
(total must equal item B
above)
0.00
1937,500.00
0.00
NRC$-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=
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U.S . Department.of AQrlc&ilture
Natu,-1 Re1MUce1 ConeetVatton Service
NONDISCRIMINATION STATEMENT
NRCS-CPM1
12/2018
The U.S. Department of Agriculture (USDA) prohibits discrimination againet i:tl customers. If you belleve you
experienced diacrlmlnatlon when obtaining seNlcea from USDA, participating In a USDA program , or
participating In a program that receives financial assistance from USDA, you may file a complaint with USDA.
Information about how to file a dlacrimination complaint Is available from the Office of the Assistant Secretary
for CMI Rights.
USDA prohibits dlacrfminatlon in all Ill programa and actlvttles on the basis of race . color, national ortgln ,
age, dlsablllty , and where appll~ble, sex (Including gender Identity and expreHion), marital status , familial
statue, parental statua, rel!glon 1 aexual orientation, political bellefa, ganettc Information, repriaal , or because
all or part of an lndilrlduara Income 11 derived from any public aasistance program . (Not all prohibited bales
apply to all programs.)
To file a complaint of discrimination, complete, sign and mail a program discrimination complaint form,
avallable at any USDA office location or online at www .ascr.usdagov, or write to:
USDA
Office of the Assistant Secretary for CMI Rlghta
1400 Independence Avenue, S.W.
Washington, D.C. 20250-9410
Or can toll free at (866) 632-9992 (voice) to obtain additional information, the appropriate office or to request
documenta. Individuals who are deaf, hard of hearing or have speech disabllitiaa may contact USDA through
the Federal Relay service at (800) an-8339 or (800) 84~138 (in Spanish). USDA is an equal opportunity
provider, employer, and lender.
Persona with disabHltiee who require alternative means for communication of program infonnation (e.g.,
Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and
TDD).
PRIVACY ACT STATEMENT
The following statements are made In accordance With the Prtvacy Act of 1974 (U.S.C. 522a). Furnishing
this Information ia voluntary; however, fallure to furnish correct, complete infQnnation will result in the
withholding or wlthdrawal of such technical or flnanclal aaalatance . The Information may be rumlished to
other USDA agenc~, the Internal Revenue Service, the Oep•-rtment of Jultice, or other State or Federal
law enforcement agencies, or In response to orders of a court , magistrate , or adminlatrative btbunaL
Thia information colectlon is exempted from the Paperwork Reduction Act under 16 U.S.C. 3801 note and
16 u.s.c. 3846.
I To be considered •• an Ellglble Entity under ACEP-ALE a non-governmental organization must be:
(1) organized for, and at au times since the fonnation of the organization been operated princ ipally for, 1 or
more of the conservation purposes specified In clause (l), (II), (Iii), or (iv) of section 170(h)(4)(A) of the
Internal Revenue Code of 1988;
(2) an organization daacrlbed In section 501 (c)(3) of that Code that ia exempt from taxation under section
501 (a) of that Code; or
(3) described In "(I) aection 509(a) (1) and (2) of that Code; or (II) section 509(a)(3) of that Code, and ia
controlled by an org~nizallon described In section 509(a)(2) of that Code.
II Select onfy one. ACEP-ALE applications are organl2ed by EHglble Land type; ACEP-ALE qreements are
specific to the Eligible Land type. The Eligible Land type wtH affect minimum deed tenns and ALE Plan .
requirement,. Applications with more than one selection may be defeffed until corrected.
Ill Historical and archHologlcal rasources mean resources that are:
(1) Listed in the National Regiater of Historic Places (established under the National Historic Preservation
Act (NHPA), 18 U.S.C. 470, et seq.);
(2) Fonnally determined eligible for listing in the National Register of Historic Places (by the State historic
preservation officer (SHPO) or Tribal hletorlc preservation officer (THPO) and the Keeper of the National
RegJater In accordance with section 106 of the NHPA);
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U.S. Department of Agriculture
Natural Reeourc&S Conservation Service
NRCS-CPA--41
12/2016
(3) Formally listed In the State or Tribal Register of Historic Place of the SHPO (designated undQr section
101 (b)(1 )(8) of.the-NHPA) or the THPO (designated under section 101 (d)(1 )(C) of the NHPA): or
(4) Included In the SHPO or THPO inventory with written justification as to wliy it meets National Register
of Historic Places criteria.
iv Certified Entity means an eligible entity that NRCS has determined to meet the requirements of
7 CFR § 1468.27. An Entity may only be certified by the Chief of NRCS.
v Parcel means a farm or ranch submitted for consideration for funding under ACEP&E.
vi Pending off~r n:ieans a written bid. contract, or option extended lo a Landowner by an eligible enuty to
8cqulre a conservation easement before the legal title to thes righbl has been conveyed for the purpose of:
(1 )The agricultural use and future viability, and related conservation va lues, of eligible land by limiting
non-agricultural uses-of that land; or
(2) Grazing uses and related conservation values by restoring and conserving eligib le land.
vil Agrlcu(tural land easement means an easement or other interest in eligible land that is conveyed for the
purpose of protecting natural resources and the agricultural nature of the land, and of promoting agricultural
viability for future generations, and permits the Landowner the right to continue agricultural production and
related uses subject to an agricultural land easement plan, as approved by the NRCS.
viii The NRCS may not use ACEP funds for the purposes of acquiring an easement on lands owned by an
agency of the United States, other than land hetd in trust for Indian Tribes; and lands owned in fee title by a
State, including an agency or a subdivision of a State, or a unit of local government. Such lands are ineligible
forACEP.
ix Purchase price means the fair market value of the agricultural land easement as detennined by an NRCS
approved methodology, minus the Landowner donation.
x Landowners shall not donate any part of the Federal share or non-Federal cash contribution back to the
entity as a condition of purchase or closing.
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