2012-01-13_REVISION - M1992058 (5)

Home Browse Search

Sec. 18. 4 eclive dale - This contract becomes effective as indicated below. 0✓ If this contract becomes effective on the date BLM signs the contract, BLM will check this box. —] If this contract becomes effective only after certain conditions are met, BLM will check this box, list the conditions below, and indicate the effective date. Sec. 19. Appeal - You may appeal any decision that BLM makes in regard to this contract under Parts 4 and 1840 of Title43 of the Code of Federal Regulations. The following parties have executed this contract as of PURCHASER Colorado Quarries Inc. (Individual or Firm Name) 270 South 15th Street, Canon City, Colorado 81212 (Address) 719 275 - 6894 Phone Number - i clud area code) f ignatur e) If you are a cgrPPrati(_ a x corporate seal here: THE UNITED STATES OF AMERICA By Keith E. Berger �� ::::::::3 : (BLM) Field Manager, Royal Gorge Field Office i (Title) T�3 /lam �— (Date) Title 18 U.S.0 100t, makes it a crime for any person knowingly or willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction subject to a fine of up to S10,000 and imprisonment up to 5 years. NOTICES The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with information required by this application. AUTHORITY: 30 U.S.C. 601 et seq.; 43 CFR 3600 PRINCIPAL PURPOSE: BLM uses this information to identify the parties entering into contracts for disposing of mineral materiLls. - ROUTINE USES: BLM will transfer in formation from the record or the record itself to appropriate Federal, State, local, or foreign agencies, when relevant to criminal, civil, or regulatory investigations or prosecutions. i EFFECT OF NOT PROVIDING INFORMATION: If you do not provide this information to BLM, we will not be able to proces your application for a contract. The Paperwork Reduction Act of 1995 requires us to inform you that: The BLM is collecting this information to process your application and effect a binding contract. The BLM will use this information to identify and communicate with applicants. You must respond to this request to get a benefit. BLM would like you to know that you are not required to respond to, this or any other Federal agency - sponsored information collection which does ,ave a currently valid OMB control number. L.,ADEN HOURS STATEMENT: Public reporting burden for this form is estimated to average about 30 minutes per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments iegarding the burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004 - 0103), Bureau Information Collection Clearance Officer (WO -630), 1849 C Street, N.W. Mail Stop 401 L S, Washington, D.C. 20240. 33 j (Form 3600 -9, page 3)