BOEM-0002 OCS Renewable Energy, Assignment of Grant

U.S. Department of the Interior
Bureau of Ocean Energy Management

OMB Control No.: 1010-0176
Expiration Date: xx\xx\202x

OUTER CONTINENTAL SHELF (OCS) RENEWABLE ENERGY
ASSIGNMENT OF GRANT
______________________
Grant No.
______________________
Grant Effective Date
Grant Type: □ Right-of-Way
□ Right-of-Use and Easement

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 (insert name and qualification number of each Assignor and Assignee below):
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.

Form BOEM-0002 (Month Year) Previous Editions are Obsolete.

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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 Qualification No.

Assignor Name:
Assignor Qualification No.

By: ________________________________
Signatory Name:
Signatory Title:

By: _________________________________
Signatory Name:
Signatory Title:

___________________________________
Execution Date

_____________________________________
Execution Date

Assignee Name:
Assignee Qualification No.

Assignee Name:
Assignee Qualification No.

By: ________________________________
Signatory Name:
Signatory Title:

By: _________________________________
Signatory Name:
Signatory Title:

___________________________________
Execution Date

____________________________________
Execution Date

Attach Notary Acknowledgement (not mandatory)
Form BOEM-0002 (Month Year) Previous Editions are Obsolete.

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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
Protraction Diagram
Or ROW Segment No.

Block

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Form BOEM-0002 (Month Year) Previous Editions are Obsolete.

Subdivision, Aliquot Part
(If entire block, enter “All”)

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