Form BSEE-0149 Assignment of OCS Pipelines ROW Grant

U. S. Department of the Interior
Bureau of Safety and Environmental Enforcement (BSEE)

OMB Control Number: 1014-0016
OMB Appoval Expires: 12/31/2024

ASSIGNMENT OF FEDERAL OCS PIPELINE RIGHT-OF-WAY GRANT
Part A: Assignment

Legal description of the Pipeline Right-of-Way Grant being assigned (Please include Segment
Number and any accessory information):

Assignor(s) does hereby sell, assign, transfer, and convey unto Assignee(s) the following undivided
right, title and interest:
Insert name and Company number of each Assignor and Assignee.
Assignor(s):

Percentage Interest Conveyed

Assignee(s):

Percentage Interest Received

 Exhibit “A,” which sets forth other provisions between Assignor(s) and Assignee(s), is attached to and
made a part of this assignment.
For BSEE Use Only – Do Not Type Below This Line
UNITED STATES OF AMERICA
This Assignment of Federal OCS Pipeline Right-of-Way Grant has been filed as of the date stamped on
this document and hereby approved by the Bureau of Safety and Environmental Enforcement on the date
below.
By_________________________________________________________________________________
Authorized Official for BSEE
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 pipeline Right-of-Way Assignments. BSEE uses the information to track ownership of Pipeline ROW Grants in the Federal
OCS. Responses are required to obtain or retain a benefit (43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.197. 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 this form, to the BSEE Information Collection
Clearance Officer, 45600 Woodland Road, Sterling, VA 20166.

BSEE FORM BSEE-0149

(10/2013 – Supersedes all previous versions of this form which may not be used.)

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Part B – Certification and Acceptance
1. Assignor(s) certifies it is the owner of the interest in the above-described Federal OCS Pipeline Right-of-Way Grant 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 record title 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 grant described herein. Applicable terms and conditions include, but are not
limited to, an obligation to conduct all operations in accordance with 30 CFR 250 and 550, Subpart J and to furnish and
maintain such bond(s) as may be required by the assignee, pursuant to regulations at 30 CFR 550, Subpart J. 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 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 Safety and Environmental Enforcement is governed by 30 CFR 250.
This Assignment of Federal OCS Pipeline Right-of-Way Grant will be made effective between the parties upon approval by the
Bureau of Safety and Environmental Enforcement, 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 Safety and
Environmental Enforcement 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 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

ASSIGNOR

By:________________________
Name:
Title:

By:__________________________
Name:
Title:

___________________________
Execution Date

_____________________________
Execution Date

ASSIGNEE

ASSIGNEE

By:________________________
Name:
Title:

By:__________________________
Name:
Title:

___________________________
Execution Date

_____________________________
Execution Date

Attach Notary Acknowledgement (not mandatory)

BSEE FORM BSEE-0149

(10/2013 – Supersedes all previous versions of this form which may not be used)

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