Form BOEM-0002 OCS Renewable Energy Assignment of Grant

U.S. Department of the Interior OMB Control No.: 1010-0176

Bureau of Ocean Energy Management Expiration Date: xx/xx/xxxx

OUTER CONTINENTAL SHELF (OCS) RENEWABLE ENERGY

ASSIGNMENT OF GRANT

______________________

Grant No.

______________________

Grant Effective Date

Grant Type: □ Right-of-Way

□ Right-of-Use and Easement

BOEM Regional Office

Part A: Assignment

This assignment is made with respect to the block(s) and/or aliquot part(s) or segments described in Exhibit “A” attached hereto and made a part hereof.

Assignor(s) does hereby sell, assign, transfer, and convey unto Assignee(s) the following undivided right, title and interest:

Assignor(s): Percentage Interest Conveyed

Assignee(s): Percentage Interest Received

□ Exhibit “B,” 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 – Do Not Type Below This Line

This Assignment of OCS Renewable Energy Right-of-Way or Right-of-Use and Easement Grant has been filed as of the date stamped on this document and hereby approved by the Bureau of Ocean Energy Management on the date below.

By___________________________________________________________________________________

Authorized Official for BOEM Title 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 right-of-way and right of use and easement granting and grant operations. The BOEM uses the information to track ownership of grants in the OCS. Responses are required to obtain or retain a benefit (43 U.S.C. 1337).  Release of such data and information is covered under 30 CFR 585.113.  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.  Direct comments regarding the burden estimate or any other aspect of the this form to the Information Collection Clearance Officer, Bureau of Ocean Energy Management, 45600 Woodland Road, Sterling, Virginia 20166.

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Part B – Certification and Acceptance

1. Assignor(s) certifies it is the owner of the interest in the OCS Renewable Energy Right-of-Way or Right-of-Use and

Easement Grant described in Exhibit A that is hereby assigned to the Assignee(s) specified above.

2. DEBARMENT COMPLIANCE: Assignee shall comply with the Department of the Interior’s nonprocurement debarment and suspension regulations as required by Subpart B of 2 CFR Part 1400 and shall communicate the requirement to comply with these regulations to persons with whom it does business related to this interest assignment by including this term in its contracts and transactions.

3. Equal Opportunity and Affirmative Action compliance certification: Assignor(s) and Assignee(s) certify

that they are 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. These requirements are for the

purpose of preventing discrimination against persons on the basis of race, color, religion, sex, or national origin. These regulations have

specific performance requirements.

4. Assignee’s execution of this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the right-of-way or right of use and easement grant described in Exhibit A. Applicable terms and conditions include, but are not limited to, an obligation to conduct all operations and to furnish and maintain such financial assurance as may be required by the Lessor pursuant to regulations at 30 CFR Part 585. This assignment is subject to the Outer Continental Shelf Lands Act of August 7, 1953, 43 U.S.C. 1331 et seq., as amended (the “Act”), and Assignee(s) is subject to, and must 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 Part 585.

This Assignment of OCS Renewable Energy Right-of-Way or Right of Use and Easement Grant will be made effective between the parties hereto as of _______________, upon approval by the Bureau of Ocean Energy Management, United States Department of the Interior.

This instrument may be executed in any number of counterparts, each of which will be deemed an original instrument, but all of which together will 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.

I certify that the statements made herein by the undersigned are true, complete, correct to the best of my knowledge and belief, and are made in good faith.

Title 18 U.S.C. 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 Name:

Signatory Title: Signatory Title:

___________________________________ _____________________________________

Execution Date Execution Date

Assignee Name: Assignee Name:

Assignor Qualification No. Assignor Qualification No.

By: ________________________________ By: _________________________________

Signatory Name: Signatory Name:

Signatory Title: Signatory Title:

___________________________________ ____________________________________

Execution Date Execution Date

Attach Notary Acknowledgement (not mandatory)

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EXHIBIT “A”

OUTER CONTINENTAL SHELF (OCS)

RENEWABLE ENERGY

ASSIGNMENT OF GRANT

The Assignment is made with respect to the following described block(s), aliquot part(s) or segments of the Grant:

Area Name or Block Subdivision, Aliquot Part

Protraction Diagram (If entire block, enter “All”)

Or ROW Segment No.

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