FS-2700-4c Private Road Special Use Permit

Authorization ID: #AUTH_ID#
Contact ID: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#
Use Code: #USE_CODE#

FS-2700-4c (REV-02/2017)
OMB No. 0596-0082

U. S. DEPARTMENT OF AGRICULTURE
Forest Service
PRIVATE ROAD SPECIAL USE PERMIT
AUTHORITY:
#AUTHORITY_NAME#
#HOLDER_NAME# of #HOLDER_ADD_LINE_1#, #HOLDER_ADD_LINE_2#, #HOLDER_ADD_LINE_3#,
#HOLDER_CITY#, #HOLDER_STATE# #HOLDER_ZIP# (hereafter called the Holder) is hereby authorized to use
National Forest lands for the construction, reconstruction, maintenance, and use of a road within the
National Forest for the following purposes:
#PURPOSE#
The lands covered by this permit are located in the County of
follows:

, State of

and are described as

#TOWNSHIP_SECT_RANGE#
#FIRST_DIVISION# #FIRST_DIV_NAME_NUMBER#, #SECOND_DIVISION# #SECOND_DIV_NAME_NUMBER#,
#THIRD_DIVISION# #THIRD_DIV_NAME_NUMBER#
This permit covers a right-of-way #ROW_LENGTH_MILES# miles in length, #ROW_WIDTH_FEET# feet in width,
containing approximately #ROW_ACRES# acres, and is located upon the ground according to the survey line, figures,
measurements, widths, and other references shown on the map or plat attached hereto as exhibit(s)
made a part hereof.

and

This permit is made subject to the following terms, provisions, and conditions:
1. This permit is subject to all existing easements and valid rights existing on this date.
2. The Holder in exercising the privileges granted by this permit shall comply with all applicable State and Federal laws,
Executive Orders, and Federal rules and regulations, and shall comply with all State standards for public health and
safety, environmental protection, and siting construction, operation, maintenance of or for rights-of-way for similar
purposes if those standards are more stringent than applicable Federal standards.
3. The Holder shall cut no timber except as authorized by construction stipulations or maintenance agreements.
4. The Holder shall provide maintenance so that no damage occurs on adjacent National Forest land. The Holder shall
construct and maintain lead-off drainage and water barriers as necessary to prevent erosion.
5. Holder shall pay the United States for all injury, loss, or damage, including fire suppression costs, in accordance with
Federal and State laws.
6. Holder shall indemnify the United States for any and all injury, loss, or damage, including fire suppression costs the
United States may suffer as a result of claims, demands, losses, or judgments caused by the Holder's use or occupancy
under this permit.
7. Holder shall pay annually in advance a sum determined by the Forest Service to be the fair market value of the use
authorized by this permit. The initial payment is set at

or the remainder of the calendar year. Payments for

each subsequent calendar year shall be the amount of
adjusted using the Implicit Price Deflator-Gross
National Product index (IPD-GNP), or other factor selected by the Forest Service, to reflect more nearly the current fair
market value of the use. At intervals to be determined by certain changes in the indexes used to establish the linear
rights-of-way fee schedule, the fee shall be reviewed and adjusted as necessary to assure that it is commensurate with
the value of the rights and privileges authorized. Failure of the Holder to pay the annual payment, late charges, or other
fees or charges shall cause the permit to terminate.
8. Pursuant to 31 U.S.C. 3717, et seq., interest shall be charged on any fee amount not paid within 30 days from the date
the fee or fee calculation financial statement specified in this authorization becomes due. The rate of interest assessed
shall be the higher of the rate of the current value of funds to the U.S. Treasury (i.e., Treasury tax and loan account rate),
as prescribed and published by the Secretary of the Treasury in the Federal Register and the Treasury Fiscal
Requirements Manual Bulletins annually or quarterly or at the Prompt Payment Act rate. Interest on the principal shall
accrue from the date the fee or fee calculation financial statement is due.
In the event the account becomes delinquent, administrative costs to cover processing and handling of the delinquency
will be assessed.
A penalty of 6 percent per annum shall be assessed on the total amount delinquent in excess of 90 days and shall accrue
from the same date on which interest charges begin to accrue.
Payments will be credited on the date received by the designated collection officer or deposit location. If the due date for
the fee or fee calculation statement falls on a non-workday, the charges shall not apply until the close of business on the
next workday.
Disputed fees are due and payable by the due date. No appeal of fees will be considered by the Forest Service without
full payment of the disputed amount. Adjustments, if necessary, will be made in accordance with settlement terms or the
appeal decision.
If the fees become delinquent, the Forest Service will:
Liquidate any security or collateral provided by the authorization.
If no security or collateral is provided, the authorization will terminate and the holder will be responsible for delinquent
fees as well as any other costs of restoring the site to its original condition including hazardous waste cleanup.
Upon termination or revocation of the authorization, delinquent fees and other charges associated with the authorization
will be subject to all rights and remedies afforded the United States pursuant to 31 U.S.C. 3711 et seq. Delinquencies
may be subject to any or all of the following conditions:
Administrative offset of payments due the holder from the Forest Service.
Delinquencies in excess of 60 days shall be referred to United States Department of Treasury for appropriate
collection action as provided by 31 U.S.C. 3711 (g), (1).
The Secretary of the Treasury may offset an amount due the debtor for any delinquency as provided by 31 U.S.C.
3720, et seq.)
9. All construction or reconstruction of the road shall be in accordance with plans, specifications, and written stipulations
approved by the Forest Service prior to beginning such construction or reconstruction.
10. The Holder shall repair fully all damage to National Forest roads and trails caused by the exercise of the privileges
granted by this permit.
11. The United States may use the roads without cost for all purposes deemed necessary or desirable in connection with
the protection and administration of the lands or resources of the United States, provided that it will use the road for

commercial hauling purposes, other than the removal of timber cut in construction or maintenance of the road or other
occasional incidental use, only after arranging to pay or perform its pro rata share of road maintenance.
12. The Forest Service alone may extend rights and privileges for use of the road constructed on the premises to other
non-Federal users provided that such users shall pay a fair share of the current replacement cost less depreciation of the
road to the holder, and reconstruct the road as necessary to accommodate their use.
13. The Forest Service retains the right to occupy and use the right-of-way and to issue or grant rights-of-way for land
uses, for other than road purposes, upon, over, under, and through the permit area provided that the occupancy and use
do not interfere unreasonably with the rights granted herein.
14. The Forest Service shall have the right to cross and re-cross the premises and road at any place by any reasonable
means and for any purpose in such manner as does not interfere unreasonably with use of the road.
15. The Holder shall maintain the right-of-way clearing by means of chemicals only after the Forest Supervisor has given
specific written approval. Application for such approval must be in writing and must specify the time, method, chemicals,
and the exact portion of the right-of-way to be chemically treated.

USER NOTES
Selection items 2 and 3 are alternative wordings which may be substituted for the standard clause as directed in FSH
2709.12, sec 43. Review each selection to identify which clause may be the most applicable and refer to FSH 2709.12,
sec.43.
Selection item 1. This is the standard clause for this authorization.
16. Unless sooner terminated in accordance with the provisions of the permit, or revoked by the Authorizing Officer,
this permit shall expire and terminate on #EXPIRATION_DATE#. The permit shall not be reissued.
Selection item 2. Alternative wording.
16. Unless sooner terminated, or revoked by the Regional Forester, this permit shall expire and terminate on
#EXPIRATION_DATE#. At that time, if the holder still needs the road for the purposes for which this permit is granted,
the permit will be reissued for a period of 10 years (or the estimated remaining life of the project, whichever is less). At
the time of reissuance, the terms and conditions may be modified and new conditions or stipulations added at the
discretion of the Forest Service.
Selection item 3. Alternative wording.
Note: If this clause is selected, remove the expiration date from top of form; leave the expiration date field blank
in the authorization screen.

16. Unless sooner terminated, or revoked by the Regional Forester, this permit shall continue as long as needed for
access to the

.

17. This permit may be terminated or suspended upon breach of any of the conditions herein, or revoked at the discretion
of the Issuing Officer.
18. Upon termination or revocation of this special-use authorization, the Holder shall remove within a reasonable time
the structures and improvements and shall restore the site to a condition satisfactory to the authorized officer, unless
otherwise waived in writing or in the authorization. If the Holder fails to remove the structures or improvements within a
reasonable period, as determined by the authorized officer, they shall become the property of the United States, but this
does not relieve the Holder from liability for the removal and site restoration costs.

19. Nonexclusive Use and Public Access. Unless expressly provided for in additional terms, use of the permit area is not
exclusive. The Forest Service reserves the right to use or allow others to use any part of the permit area, including roads,
for any purpose, provided, such use does not materially interfere with the holder's authorized use. A final determination of
conflicting uses is reserved to the Forest Service.
20. Forest Service Right of Entry and Inspection. The Forest Service has the right of unrestricted access of the
permitted area or facility to ensure compliance with laws, regulations, and ordinances and the terms and conditions of this
permit.
21. Liability. For purposes of this section, "holder" includes the holder's heirs, assigns, agents, employees, and
contractors.
A. The holder assumes all risk of loss to the authorized improvements.
B. The holder shall indemnify, defend, and hold the United States harmless for any violations incurred under any
such laws and regulations or for judgments, claims, or demands assessed against the United States in connection
with the holder's use or occupancy of the property. The holder's indemnification of the United States shall include any
loss by personal injury, loss of life or damage to property in connection with the occupancy or use of the property
during the term of this permit. Indemnification shall include, but is not limited to, the value of resources damaged or
destroyed; the costs of restoration, cleanup, or other mitigation; fire suppression or other types of abatement costs;
third party claims and judgments; and all administrative, interest, and other legal costs. This paragraph shall survive
the termination or revocation of this authorization, regardless of cause.
USER NOTES FOR "C" CLAUSE
Selection item 1. This selection is the default liability clause for all authorizations. Use this clause when one of the
following conditions exist: (1) The holder is NOT a Federal Agency, State or political subdivision thereof; (2) the
authorized officer determines that the risk to public land, resources, or interest is NOT greater than the holder's assets
or ability to correct and; (3) the use is NOT a high-risk or poses a high hazard (such as high-voltage power lines, oil
and gas pipelines, large dams or reservoirs, and so forth, which could expose the government to significant injuries,
losses or damages in the event of malfunction).
C. The holder has an affirmative duty to protect from damage the land, property, and interests of the United
States.
Selection item 2. Use in situations in which the authorized officer determines that the risk to public land, resources,
or interest is greater than the holder's assets or ability to correct.
If holder is a State or political subdivision thereof and such entity has statutory or constitutional authorities limiting the
amount of liability or indemnification payable, the authorized officer shall prepare a risk assessment to determine the
United States potential for losses due to personal injury, loss of life, or property damage caused by the State's use or
occupancy. If the authorized officer determines, through the risk assessment that the potential for injury, loss, or
damage caused by the State's use or occupancy is in excess of the State's liability limitation, the State shall procure,
as a requirement to be fulfilled before execution of this permit, insurance, and name the United States, together with
the State, as an insured on the policy(ies), in the amount determined in the risk assessment that exceeds the State's
liability limitation.
C. The holder has an affirmative duty to protect from damage the land, property, and interests of the United
States.
The holder shall maintain #LIAB_INS_AMOUNT# worth of insurance coverage, naming the United States additionally
insured on the policy(ies), to partially fund the indemnification obligations of the holder for any and all losses due to
personal injury, loss of life, or property damage, including fire suppression and hazardous waste costs. The holder
shall furnish proof of insurance (such as a surety bond, or certificate of insurance) to the Authorized Officer prior to

execution of this permit and verify annually, and in writing, the insurance obligation to the Authorized Officer. The
Authorized Officer may allow the holder to replace, repair, restore, or otherwise undertake necessary curative actions,
to the satisfaction of the Authorized Officer, in order to mitigate damages in addition to or as an alternative to
monetary indemnification.
Selection item 3. Use if the authorized use is a high-risk or poses a high hazard (such as high-voltage power lines,
oil and gas pipelines, large dams or reservoirs, and so forth, which could expose the government to significant
injuries, losses, or damages in the event of malfunction).
C. The holder has an affirmative duty to protect from damage the land, property, and interests of the United
States.
The holder shall be strictly liable (liability without proof of negligence) to the United States for any injury, loss, or
damage arising under this authorization. Such strict liability shall be in the amount of $1 million unless the Forest
Supervisor determines at the time of issuance of this authorization that a lesser amount of strict liability is appropriate
based upon a risk assessment for the use authorized by this instrument. Liability for injury, loss, or damage to the
United States in excess of the prescribed amount of strict liability shall be determined under the general law of
negligence.
Selection item 4. Use if the authorized use is a high-risk or poses a high hazard (such as high-voltage power lines,
oil and gas pipelines, large dams or reservoirs, and so forth, which could expose the government to significant
injuries, losses, or damages in the event of malfunction) AND in situations in which the authorized officer determines
that the risk to public land, resources, or interest is greater than the holder's assets or ability to correct.
If the holder is a State or political subdivision thereof and such entity has statutory or constitutional authorities limiting
the amount of liability or indemnification payable, the authorized officer shall prepare a risk assessment to determine
the United States potential for losses due to personal injury, loss of life, or property damage caused by the State's use
or occupancy. If the authorized officer determines, through the risk assessment that the potential for injury, loss, or
damage caused by the State's use or occupancy is in excess of the State's liability limitation, the State shall procure,
as a requirement to be fulfilled before execution of this permit, insurance, and name the United States, together with
the State, as an insured on the policy(ies), in the amount determined in the risk assessment that exceeds the State's
liability limitation.
C. The holder has an affirmative duty to protect from damage the land, property, and interests of the United
States.
The holder shall maintain #LIAB_INS_AMOUNT# worth of insurance coverage, naming the United States additionally
insured on the policy(ies), to partially fund the indemnification obligations of the holder for any and all losses due to
personal injury, loss of life, or property damage, including fire suppression and hazardous waste costs. The holder
shall furnish proof of insurance (such as a surety bond, or certificate of insurance) to the Authorized Officer prior to
execution of this permit and verify annually, and in writing, the insurance obligation to the Authorized Officer. The
Authorized Officer may allow the holder to replace, repair, restore, or otherwise undertake necessary curative actions,
to the satisfaction of the Authorized Officer, in order to mitigate damages in addition to or as an alternative to
monetary indemnification.
The holder shall be strictly liable (liability without proof of negligence) to the United States for any injury, loss, or
damage arising under this authorization. Such strict liability shall be in the amount of $1 million unless the Forest
Supervisor determines at the time of issuance of this authorization that a lesser amount of strict liability is appropriate
based upon a risk assessment for the use authorized by this instrument. Liability for injury, loss, or damage to the
United States in excess of the prescribed amount of strict liability shall be determined under the general law of
negligence.
D. In the event of any breach of the conditions of this authorization by the holder, the Authorized Officer may, on
reasonable notice, cure the breach for the account at the expense of the holder. If the Forest Service at any time

pays any sum of money or does any act which will require payment of money, or incurs any expense, including
reasonable attorney's fees, in instituting, prosecuting, and/or defending any action or proceeding to enforce the United
States rights hereunder, the sum or sums so paid by the United States, with all interests, costs and damages shall, at
the election of the Forest Service, be deemed to be additional fees hereunder and shall be due from the holder to the
Forest Service on the first day of the month following such election.
E. With respect to roads, the holder shall be proportionally liable for damages to all roads and trails of the United
States open to public use caused by the holder's use to the same extent as provided above, except that liability shall
not include reasonable and ordinary wear and tear.
F. The Forest Service has no duty to inspect the permit area or to warn of hazards and, if the Forest Service does
inspect the permit area, it shall incur no additional duty nor liability for identified or non-identified hazards. This
covenant may be enforced by the United States in a court of competent jurisdiction.
22. Members of Congress. No Member of or Delegate to Congress or Resident Commissioner shall benefit from this
permit either directly or indirectly, except when the authorized use provides a general benefit to a corporation.
23. Appeals and Remedies. Any discretionary decisions or determinations by the authorized officer are subject to the
appeal regulations at 36 CFR 214 as amended.
24. Assignability. This authorization is not assignable or transferable. If Holder, through death, voluntary transfer,
enforcement of contract, foreclosure, or other valid legal proceeding shall cease to be owner of the above-described real
property accessed by the authorized road, this authorization will terminate.
25. Superior Clauses. In the event of any conflict between any of the preceding printed clauses or any provision thereof
and any of the following clauses or any provision thereof, the preceding printed clauses shall control.
#INSERT TERM HERE#
Add Regional/Forest clauses here to address local conditions.
In Witness Whereof, the parties hereto have caused this authorization to be duly executed on this

day of

.

Holder
By:

USDA - Forest Service
By:

#HOLDER_NAME#
Forest Supervisor
National Forest
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