Laserfiche WebLink
SBC. 18. EJ1reti ee doer. This contract becomes effrcti~e as indicated belo~~. <br />_1 If this contract becomes effective on [he date BLDI signs the contract, BL~~I gill check this bor. <br />tJ If this contract becomes effective only' niter certain conditions are met, BL\I will check this bos, list the conditions below, an[I <br />indicate the effective date. <br />Sec. 19. Appeal You may appeal any decision that BLM makes in regard to this contract under Parts 4 and 18=10 of Title 43 of the Code <br />of Federal Reeulations. <br />The following parties have executed this contract as of <br />PURCHASER THE UNITED STATES OF AMERICA <br />~~6rCC1~ G ©GtlL,r/1 Pte' B~. `- _-- <br />(Individual or Firm Name) <br />(Address) IAut nmd OI'ti«n <br />If}uu are a corporation, affix corporate seal here: <br />(Yule) <br />(Date) <br />Title 13 U.S.C. Section IOOI, makes it a crime for any person knowingly or willfull}~ to make to anv department or agency of the United <br />Stales any False, 6etitious or fraudulent statements or representations as to any matter within its jurisdiction. subject to a tine of up to <br />510,000 and imprisonment up to 5 years. <br />fhc Paperm uri: Redoetion Ac[ of 1995 iJ-l US.C'. 3501 et seq.; ~ ROii TI\'E USES: `,'L`a ui!! t: ur;sror intbrmatinn :~em the rcccrd <br />reyuircs us to inform you [hat: or the record itself to appropriate federal, state. locate or foreign <br />BLM is collective this information to process }'our application agencies, ohrn «Izs an[ to criminate cis il. ur rrgulawp <br />and effect a binding contract. ~ inrestigations or prosecutions. <br />BL:bI ~~ill use this information to iden[ih~ and communicate with EFFECT OF XOT PROVIDING I\'FORlL-\"FIO\~. If you do not <br />applicants. pru~ide this information w BL\I. ~~c Dill not hr .ibla to pn+cav <br />l~uu must respond to this reyuest w .et a banetit. ? our applicttion for a amu.+et. <br />.A faderal aerncy ma} not conduct or sponsor, and you are no[ BL~I estimates [he public reporting burden for this form a! un <br />reyuired m respond w. an information collection r~hich doa not ~ a~era~e of 30 minutes per response. including the time for <br />have a currentl} valid OMB control number. ( rep iewine instructions. ea[hertn~ and msintainine data. and <br />.\I'THORIi\'~ 30 l'.S.C. 601 rt pry.: y3 CFR 3600 complatine and rosie«in_ the form. Direct commenu «aardina <br />tier burden asumau ur am other aspect of this form to l~.S. <br />PR!\C'IPAL PURPOSE: BL:11 us,s [his information to idrnutj ~ Department of [he Interior. Bureau of Land l~lanaeemrnt. Bureau <br />[he parties entering into contracts for disposing of mineral I Inform a[ion Collection Clearance OFticer. 11001-OI03t. ItiS~1 C <br />materials. '~ 5:.. S. q~.. AI;til Stop y0l LS. AVashing[on. U.C. 30'3U <br />EXHIBIT N <br />