Form BOEM-150 Assignment of Record Title Interest in Federal OCS Oil a

U.S. Department of the Interior

OMB Control No.: 1010-0006
Expiration Date: xx/xx/2022

Bureau of Ocean Energy Management

Lease No.
Lease Effective Date

ASSIGNMENT OF RECORD TITLE INTEREST IN
FEDERAL OCS OIL AND GAS LEASE

New Lease No. (BOEM Use Only)

Part A: Assignment

Legal description of the OCS oil and gas lease or the officially designated subdivision of the lease
being assigned:

Assignor(s) does (do) hereby sell, assign, transfer, and convey unto Assignee(s) the following undivided
right, title and interest (insert name and qualification number of each Assignor and Assignee below):
Assignor(s):
Percentage Interest Conveyed

Percentage Interest Received

Assignee(s):

The approval of this assignment is restricted to record title interest only.
Exhibit “A,” which sets forth other provisions between Assignor(s) and Assignee(s), is attached to and
made a part of this assignment.
For BOEM use only
This Assignment of Record Title Interest has been filed as of the date stamped on this document and is hereby
approved by the Bureau of Ocean Energy Management on the date shown below.
By
Authorized Official for BOEM

Title

BOEM Approval Date

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to use in the
adjudication process involved in leasing and lease operations. BOEM uses the information to track ownership of leases in the Federal OCS. Responses are
required to obtain or retain a benefit. Proprietary data are covered under section 26 of the OCSLA, 30 CFR 556.10, and in accordance with regulations in 30
CFR parts 550, 551, and 552. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB Control Number. Public reporting burden of this form is estimated to average 30 minutes per response, including the time for reviewing
instructions, gathering and maintaining data, and completing and reviewing the form. Comments on the burden estimate or any other aspect of this form should
be directed to the Information Collection Clearance Office, Bureau of Ocean Energy Management, 45600 Woodland Road, Sterling, VA 20166.

BOEM-0150 (Month 2019)
Previous Editions are Obsolete.

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Part B: Certification and Acceptance
1.

Each Assignor certifies it is the owner of the record title interest in the above-described lease that is hereby assigned to the Assignee(s) specified
above.

2.

DEBARMENT COMPLIANCE: Each Assignor and Assignee certifies its compliance with the Department of the Interior’s nonprocurement
debarment and suspension regulations at 2 CFR Subtitle B, Part 1400, and agree to communicate the requirement to comply with these regulations
to persons with whom it does business related to this record title interest assignment by including the terms of the regulations in its contracts and
transactions.

3.

EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION COMPLIANCE CERTIFICATION: Each Assignor and Assignee certifies that it
is in full compliance with Equal Opportunity Executive Order 11246, as amended, and the implementing regulations at 41 CFR 60-01 – Obligations
of Contractors and Subcontractors; and 41 CFR 60-2 – Affirmative Action Programs.

4.

QUALIFICATIONS of ASSIGNOR(S) and ASSIGNEE(S): Each Assignor and Assignee certifies that it: is established and officially
recognized by the Bureau of Ocean Energy Management as qualified and authorized to bid on, acquire interests in, and hold OCS oil and gas
leases; is exercising and meeting due diligence requirements on any other OCS lease in accordance with section 8 of the OCSLA, as amended (43
U.S.C. 1337(d)); is in good standing with acceptable operating performance as required by 30 CFR §§ 550 and 556; is not disqualified by BOEM
from acquiring any new OCS leases or assigned interest(s) in existing leases because of unacceptable operating performance on any other OCS
lease; is not failing to meet or exercise due diligence (as determined by BOEM after notice and opportunity for a hearing under 30 CFR part 590,
subpart A); and is not restricted from bidding or acquiring interests in the lease or officially designated subdivision, therein, or grouped with any
other entities on the restricted joint bidders list.

5.

Assignee’s execution of this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the
lease described herein. Applicable terms and conditions include, but are not limited to, an obligation to conduct all operations on the leasehold in
accordance with the terms and conditions of the lease, to condition all wells for proper abandonment, to restore the leased lands upon completion of
any operations as described in the lease, and to furnish and maintain bond(s) pursuant to regulations at 30 CFR §§ 550 and 556. This assignment is
subject to the Outer Continental Shelf Lands Act of August 7, 1953, 67 Stat. 462; 43 U.S.C. 1331 et seq., as amended (the “Act”), and Assignee(s)
is (are) subject to, and shall fully comply with, all applicable regulations now or to be issued under the Act. Notwithstanding any agreement
between the Assignor(s) and Assignee(s), the parties’ liability to the Bureau of Ocean Energy Management is governed by 30 CFR §§ 550 through
556.
This Assignment of Record Title Interest will be made effective between the parties hereto as of
Bureau of Ocean Energy Management, United States Department of the Interior.

, upon approval by the

This instrument may be executed in any number of counterparts, each of which will be deemed an original instrument, but all of which together
shall constitute but one and the same instrument provided, however, this instrument and any other counterpart hereof, will not be binding unless and
until executed by all of the parties, and will not be accepted by the Bureau of Ocean Energy Management unless all counterparts are filed
simultaneously.
By signing this document, you certify that your statements made herein are true, complete and correct to the best of your knowledge and belief and
are made in good faith.
Title 18 U.S.C. Sec. 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.

Assignor Name:

Assignor Name:

Assignor Qualification No.

Assignor Qualification No.

By:______________________________________

By:______________________________________

Signatory Name:
Signatory Title:

Signatory Name:
Signatory Title:

Execution Date

Execution Date

Assignee Name:

Assignee Name:

Assignee Qualification No.

Assignee Qualification No.

By:______________________________________

By:______________________________________

Signatory Name:
Signatory Title:

Signatory Name:
Signatory Title:

Execution Date

Execution Date

BOEM-0150 (Month 2019) Previous Editions are Obsolete.

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