Form 4120-6 Cooperative Range Improvement Agreement

Form 4120-6 (xxxxx, 2013) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT COOPERATIVE RANGE IMPROVEMENT AGREEMENT	FORM APPROVED OMB NO. 1004-0019 Expires: xxxxxxxxx xx, 2013
	FOR BUREAU OF LAND MANAGEMENT USE ONLY
	State. . . . . . . . . . . . . . . . . . . . . . . . . . . . Office . . . . . . . . . . . . . . . . . . . . . . . . . .
	Project Number(s)
INSTRUCTIONS - Cooperator(s) to receive original, and one copy each to the District/Field Office case or lease file and District/Field Office project file.	Project Name(s)

1. I, (We) of of of

and of

hereinafter called cooperator(s) and the United States of America, by the Bureau of Land Management, hereinafter called the BLM, for and in consideration of the mutual benefits hereunder, and in accordance with the Taylor Grazing Act (43 U.S.C. 315, 315a-r), as amended, the National Soil Conservation Act (16 U.S.C. 590a(3)), as amended, the Federal Land Policy and Management Act (43 U.S.C. 1701, et seq.), and the Public Rangelands Improvement Act (43

U.S.C. 1904) do enter into this cooperative agreement for the construction and/or maintenance of range improvements, installation of conservation works or establishment of conservation practices, hereinafter referred to collectively as improvements, for the benefit of the public lands and of the cooperator(s).

_{2. The improvement(s) known as the}

will be

is (are) located upon: 1/4, Sec(s). T, R, ,

are

_{Meridian, County of , State of ,}

3. IT IS MUTUALLY AGREED:

(a) The parties hereto will furnish labor, materials, and equipment as required, the total cost of value not to exceed the amount listed below for each of the parties respectively for the initial construction and/or installation of the improvements indicated in paragraph 2.

NAME(S) OF COOPERATOR(S)	ITEMS	TOTAL COST OR VALUE
		$
BUREAU OF LAND MANAGEMENT

(Continued on page 2)

AGGREGATE COST $

(b) Upon notice from the BLM, cooperator(s) will promptly supply labor, materials, and equipment as specified in paragraph 3 (a) as required. Contributed materials in excess of the amount required must be returned to the contributor. Equipment contributed must be returned promptly following completion of the work. Work will be conducted under the supervision and direction of the BLM and must be pursued with

diligence until completed.

4. (a) The cooperator(s) will be liable, jointly and severally, for the repair and maintenance of the improvements following completion, in good and serviceable condition. The cooperator(s), without further notice from the BLM must do the necessary work promptly. If work is not performed as necessary, the BLM will notify the cooperator(s) and specify a period within which to complete the work as required.

(b) In event the cooperator(s) default in the repair and mainten ance of the improvements the BLM may do or cause such work to be done for

and in behalf of the cooperator (s); and the necessary cost and expense

thereof will become a charge and obligation upon and must be paid by the cooperator(s). It is further understood in case of default that any grazing permit or lease may be canceled and may not be renewed or extended or any transfer of grazing preference may not be approved unless and until all charges and costs owed by the cooperator(s) are paid; and provided that the BLM may pursue such other remedies, legal or administrative, as may be authorized.

(c) Repair and maintenance, as herein required, will mean normal upkeep and maintenance necessar y to preserve, protect, and prolong the useful life of th e improvements, but will not include major repairs where the damage is due to floods, earthquakes, or other acts of God, or fire not the result of fault or negligence of the cooperator(s) as determined by the BLM.

5. IT IS FURTHER AGREED

(a) This agreement does not convey right, title, or in terest in any lands or resources held by the United States.

(b) Title to permanent or nonstructural improvements authorized by

this agreement is held by the United States of America. The actual amount of the cooperator's(s') funds, materials, and the value of the labor contributed to the construction of the range improvement(s) authorized by this agreement is listed in Section 3 of this agreement and documents their respective interest in the agreement.

(c) The improvements may be removed, in whole or in part, during the term of this agreement or any extension thereof, by mutual consent of the

parties or by d irection of the BLM; such removal must be made by th e cooperator(s), or by the BLM at its option. During the course of

salvaging material, the United States assumes no responsibility for the protection or preservation of said material. Upon removal of the

improvements, any salvageable materials, after deducting an amount to compensate for the actual cost of removal, will be available for

distribution to the parties then subject to this agreement in propo rtion to the actual amount of their respective contributions to the initial

construction of the improvements. The pa rties must take posse ssion a nd remove their portion of the salvaged materials within one hundred and

eighty (180) days af ter f irst notificati on in writing that such material is available; upon failure to do so within the time allowed, the materials will

be deem ed abandoned and t itle thereto will thereupon vest in the

United States.

(d) In the event lands containing improvements described under (b) above are devoted to another public purpose which precludes grazing , including disposal, the cooperator(s) will be entitled to reasonable compensation for the adjusted value of the cooperator’s(s’) interest to the improvements.

6. Applications by the cooperators(s) to transfer the grazing preference and/or permitted grazing use embracing the lands upon which the improvements are constructed or in connection with which they are used, will evidence assignment of interest in this Cooperative Agreement to the transferee. [Before the tr ansferee will be recognized as successor in interest hereunder, the transferee will be required by the BLM to accept an assignment of this agreement and agree to be bound by the provisions respecting the use and maintenance of the improvements.]

7. The coop erator’s(s’) use of the improvements will be in conformance with any spec ial cond itions, the grazing permit(s) or lease(s), and regulations of the Secretary of the Interior.

8. This agreement will not accord to cooperator(s) any preference, privilege, or consideration with respect to any grazing permit or lease not expressly provided herein or in the rules and regulations governing such grazing permit or lease.

9. Items 2, 3, and 4 (a) of this agreement may be modified or canceled by written agreement of the parties, which agreement will become a part hereof.

10. This agreement is subject to the provisions of Executive Order No.

11246 of September 24, 1965, as amended, which sets forth the

nondiscrimination clauses. A copy of this order may be obtained from the

BLM.

11. This agreement will remain in effect indefinitely from date of signature unless (1) otherwise designated under item 14 . Special Conditions, or (2) terminated by mutual written consent of parties, or (3) terminated by the BLM after notice in writing because of the cooperator’s(s’) default

or violation (4) terminated by the BLM after notice in writing because the improvements are not compatible with adopted land use plans, or (5) terminated renegotiated, or modified by the BLM following consultation with the parties involved, as a result or changes in law regulation, or national BLM policy.

12. Any water right acquir ed o n or after August 21, 1995 to use water on public lands associated with this improvement will be held in the name of the United States, if permitted under State Law. Co-application or joint ownership by permittees or lessees of water rights for purposes of livestock water will be allowed where State Law permits the practice.

13. Any water developed, improved, or impounded under this cooperative agreement will be available for wildlife and free roaming wild horse and burros use and other authorized public use to the extent that such use is consistent with the multiple-use management objectives for the area.

_{14. Special Conditions}

_{COOPERATOR(S) THE UNITED STATES OF AMERICA}

State of (Signature) (Date)

District/Field Office (Signature) (Date)

By (Signature) (Date) (Signature)

_{(Signature) (Date) (Title)}

_{(Signature) (Date) (Date)}

Title 18, U.S.C., Section 1001, makes it a crime for any person knowingly and 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.

LOCATION PLAT

_{Sec. , T. , R. , Mer.}

Scale inches equals one mile

NOTICES

The Privacy Act and 43 CFR 2.48(d) require that you be furnished the following information in connection with the information requested by this form.

AUTHORITY: 43 U.S.C. 315, 43 U.S.C. 1752, 43 U.S.C. 1904 and subpart 4120 permit collection of the information requested by this form.

PRINCIPAL PURPOSE: The BLM will use the information you provide to develop a cooperative agreement for the construction, use, and maintenance of range improvements on its public lands. The information will be used to document specific participation of each cooperator on the range improvement(s) to be accomplished under the cooperative agreement.

ROUTINE USES: In accordance with the Bureau of Land Management’s (BLM) System of Records Notice published in the Federal Register on December 29, 2010 [Bureau of Land Management’s Range Management System—Interior, LLM-2; Notice To Amend an Existing System of Records; Privacy Act of 1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM public website.

EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain or retain a benefit. Failure to submit all the requested

information or to complete this form may result in delay or rejection and/or denial of your application.

The Paperwork Reduction Act requires that you be furnished the following information in connection with the information requested by this form: BLM collects this information to authorize range improvements on public lands. Response to this request is required in order to obtain or retain a benefit. You do not have to respond to this or any other Federal agency-sponsored information collection unless it displays a valid OMB Control Number.

BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0019), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240.