Form BSEE-0135 Identification of Right-of-way Pipeline Operator

U.S. Department of Interior OMB Control No.:

Bureau of Safety and Environmental Enforcement Expiration Date:

Identification of Right-of-way Pipeline Operator

The companies identified below are on record with the Bureau of Safety and Environmental Enforcement (BSEE), as a partial grant holder of:

Pipeline Right-of-way Grant Number (OCS or OCS-G):

Regional Office:

who hereby identifies

Name of Operator:

Address:

as operator of the right-of-way (ROW) pipeline identified above and as operator with, subject to the relinquishment and modification limitation stated below, full authority to act on the ROW grant holder’s behalf and to fulfill the grant holder’s obligations under the OCS Lands Act, in compliance with the terms and conditions of the ROW grant, laws and applicable regulations. The BSEE Regional Supervisor, or the authorized BSEE Regional Officer, may provide the identified ROW pipeline operator written or oral instructions in securing compliance with the ROW grant in accordance with applicable laws and regulations. This identification of ROW pipeline operator is made with respect to the ROW pipeline segment number described below:

□ Check here if description continued on attached sheet.

(Insert ROW grant description, including ROW and Pipeline Segment Numbers)

It is understood that this identification of a ROW pipeline operator does not relieve the grant holder of responsibility for compliance with the terms of the ROW grant and all applicable laws and regulations. It is also understood that this identification of the ROW pipeline operator itself does not constitute an assignment of any interest in the ROW grant.

In case of default on the part of the identified ROW pipeline operator, all ROW grant holders will make full and prompt compliance with all laws, regulations or orders of the Secretary of the Interior or his/her representative. If BSEE determines the ROW pipeline operator’s performance being conducted on the pipeline ROW described above is unacceptable, BSEE may disqualify the ROW pipeline operator, or may disapprove or revoke its identification of ROW pipeline operator. The ROW pipeline operator will be given adequate notice and opportunity for a review by BSEE Regional officials before initiating or imposing a disqualification. The BSEE Regional Director may require the pipeline ROW grant holders to identify/name an operator empowered to fulfill the pipeline ROW grant holder’s obligations under the OCS Lands Act or governing regulations.

The ROW pipeline operator does not have the authority to relinquish or modify the pipeline ROW grant described above unless all pipeline ROW grant holder’s join in the execution of a relinquishment or modification application with the ROW pipeline operator.

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The grant holders agree to notify the Regional Supervisor promptly of any change in the identified ROW pipeline operator. The identified ROW pipeline operator shall comply with the Department of the Interior’s non-procurement debarment and suspension regulations as required by Subpart A of 2 CFR Part 180 and 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 identification by including this term in its contracts and transactions.

Identified ROW Pipeline Operator and GOM ID Number:

By: ___________________________________

Signatory Name:

Signatory Title:

Date: _________________________________

ROW Holder ROW Holder

By: By:

Name: Name:

Title: Title:

Date Date

ROW Holder ROW Holder

By: By:

Name: Name:

Title: Title:

Date Date

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that BSEE collects this information to be informed of who is authorized to act on behalf of the Right-of-Way grant holder(s) to fulfill their obligations under the OCS Lands Act and applicable regulations, and who is authorized to receive notices and comply with regulatory orders issued. Responses are mandatory (43 U.S.C. 1331 et seq.). No proprietary information is collected. An agency may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden for 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. You may direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Bureau of Safety and Environmental Enforcement, 45600 Woodland Rd, Sterling, VA 20166.

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