PERMFILE139808

• Permit No: M1988087
• IBM Index Class Name: Permit File
• Doc Name: Application
• Section_Exhibit Name: EXHIBIT A
• Media Type: D
• Archive: No

PRI VA.CY ACT
Tho Prlveey Aol of 1974 end lha reNletlon In 43 CFR 2.48(d) provlda that you ba
fumiehed lha fellowing (nfetmetlon In oonneetlen wllh U[otmetlon required by th le
appllcatloa.
AUTHORITY: 30 U.S.C. 601 et, seq.; 43 CFR 3600
PRINCIPAL PURPOSE: The In[ormetlon Is to be used to idenllfy the parties
entering into a contractual agreement Cor the QLaposaS of mineral materiels.
ROUTINE USES: (1) Contact epDUcents or permltteee about matters pertaining
to a contract or permit for the sale or free use oL minerel meteNele from public
lends. (2) Report sales lnfomtetion to Congreae pursuant to 30 U.S.C. 601 et. seq.
(3) Exeeute a contractual agreement for the diapoeal of mineral metertale from
public lends. (4)(5) Information from the record and/or the record will be trette-
fened to appropriate Federal, State, local or foreign egenctee, when relevant to
civil, criminal or reNlatory investigaUone or proaecutlons.
EFFECT OF NOT' PROVIDING INFORMATION: Providing this information la
mandatory to obtain a contract or permit for the dfepoeel of mineral materiels from
public tends.
Purchaser shrill be liable [or all lass suffered i[ Purchaser, his con-
trectora, or attbcontrectors, or employees o[ any o[ them, are dlrcctly
or indirectly responsible (or the damage. If such materiel la dam-
aged or ,destroyed without fault on their part, Purchaser shell be
Ueble [or loss eustalned to the extent that it is caused by his
failure to serer, exVact, or remove the damaged materiel under the
dreumatancen and terms of this contract except that nothing herein
shell be coea:rued to rolleve either party from llebility for breech o[
convect or any wrongful or negligent act
Sec. 4. Speci,rl clauses and reserved items -The rights of Purchaser
shell be subJeet to the reguletlona to 43 CFR, Group 3600, (which
are made a port of this contract), subject to Section 9 0[ this con-
tract, and i[ this box ~ ie checked the following stipulations
marked Exhibit H, which ere attached hereto end made a pert hereof.
The attached etipuletlone appear es conaecutlvely
numbered pages commencing with page 1 hereafter. [f no stlpuletiona
are attached this box ~ shell be marked.
$e<. 5. Bond:: - (o) The Purchaser shell file with the Authorized
ORicer end et~ell melntain at e11 times [he bonds required under the
regulations in 43 CFR 3610.1-5 to be furnished as a condition to
the issuance of this contract in the amounts eatabllehed by the
Authorized Officer.
(b) If all terms of the convect ere not faithfully end fully per-
formed by Purchaser, the performance bond required by •{3 CFR
3610.1-5 1n the anm of x25,000.00 riled ^c the
time o[ the sighing of this contract shell be forfeited to the amount
of damages determlaed by the Authorized Officer. IL demegee ezceed
the emounf of the bond, Purchaser hr:rcby •cknowledgee llablllty for
ouch excess. Vpoa satlefactory performance o[ thin cortVaet, the
bonds shall be canceled, or it cash or United Staten boada were
fumlehed >n lleu o[ a surety bond, such cash or securitlee shell be
returned to Purchaser.
(c) Whenever any bond [umiehed under this contract la found
onsatlefectory by the Authorized Officer, he may require a new bond
which le eallsfectory to him.
Se<. 6. Expiration of con[racr -This contract shall expire one (1)
years from the date of approval unless en e:tenslon o[ time le
granted.
$ac. 7. Equal opportunity douse -This permit la subJeet to the
provlalona oC Executive Order No. 11246 of Sept. 24, 1965, es e-
mended, which seta forth the nondier:rimination clauses. A copy oL
thla order may be obtained from the signing officer.
Sac. B. ~Appea! - An appesl es provided by the regulations of [he
Department of the Interior may be taken from any declalon o[ any
eubordlnete o[flciel to the Director, Bureau of Lend Management,
end from the Dlrector'e decision tc the Secretary o[ the Interor
pursuant to the Rules oC Practice (43 CFR, Pert 1840)•
$ec. 9. Special Stipulations - (stipulations, i/ any, are attached berefo and made a part bereo/)
ATTACHED
*The bond filed with Colorado Mine Land Reclamation in the amount of $25,000 will suffice
insofar <1s the U.S. Government is named as being additionally covered.
IN WITNESS WHEREOF, the parties hereto have executed this contract es the day Eirst above written.
PURCHASER
(Individual or Finn Name)
(Address)
(Signature)
THE UNITED STATES OF AMERCCA
(Authorized Officer)
Area Manager
(Title)
(Date)
(Signature)
I/ this con trap is eze toted by n corporation, it must a//iz its rnrporate sera(
The Peperu•orl: Reduction Act of 1980 (44 U.B.C. 3501, et. seq.) requires us to inform you that:
`Phis infordl@flan lu 6@In~ collect@d to ¢ieces5 your @¢¢ilcathid field @t(Ct:f @ {5{hdlag coiftiactutil sgreement.
This, Informatlnd will be uadd {o ItIeHlifV nfld 6ommi~le with dp¢il@dH1A. •