Vault_Pumping_SOW_revised.docx

SCOPE OF WORK FOR

IMPERIAL AND LA POSA VAULT PUMPING

BLM, Yuma Field Office, Yuma, Arizona

TABLE OF CONTENTS

SECTION

B LOCATION 2

C DESIGNATED REPRESENTATIVES 2

D PERIOD OF PERFORMANCE 2

E GENERAL REQUIREMENTS 3

F SPECIFIC REQUIREMENTS 5

G MEETINGS/COORDINATION 8

H SCHEDULES AND SUBMITTALS 9

I SAFETY 14

J HOLD HARMLESS 14

K INSURANCE 15

L PAYMENTS 17

ATTACHMENT A: MAPS

ATTACHMENT B: SELF-INSURANCE REQUIRMENTS FORM

ATTACHMENT B: NON-SELF-INSURANCE REQUIRMENTS FORM

SCOPE OF WORK FOR

IMPERIAL AND LA POSA VAULT PUMPING

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

A. BACKGROUND & PURPOSE

The Yuma Field Office (YFO) manages 1.2 million acres of public lands across Arizona and California. The Bureau of Land management (BLM) manages recreation sites including restroom facilities among other amenities for the public to enjoy.

The purpose of this contract is to remove, through pumping, sewage from 21 Arizona and 26 California sewage vaults, RV dump stations, and septic holding facilities throughout the Yuma Field Office management area. This statement of work is for one (1) award for all standard pumping outlined in the tables below. All additional facilities added and emergency pumping will be quoted and awarded upon approval of implemented action.

B. LOCATION

Of the 21 Arizona vault toilets, dump stations and septic holding facilities, 19 are located directly south of Quartzsite, Arizona within the La Posa Long-term Visitor Area (LTVA). In addition, there are two restroom facilities located adjacent to Mittry Lake near Yuma, Arizona.

Of the 18 California vault toilets, dump stations and septic holding facilities, 16 are located between Winterhaven, CA and Yuma, AZ along the lower Colorado River, within the Imperial Dam Recreation Area. In addition, there are 2 sewage vaults and a septic holding facility along the Colorado River in the Oxbow Campground near Palo Verde, CA.

The table with specific vault toilets and locations is in Section H on page 9.

C. DESIGNATED REPRESENTATIVES

1. The Primary Contracting Officer Representative (COR) is Raymond Castro Jr., BLM YFO 7341 E. 30th Street Suite A, Yuma, AZ 85365; 928-317-3251; 928-276-2027; rcastro@blm.gov

2. The Project Inspectors (PI) are Bill Alexander, BLM YFO 7341 E. 30th Street Suite A, Yuma, AZ 85365; 928-317-3221; 928-580-0486; balexand@blm.gov and Martin Gibson, BLM YFO 7341 E. 30th Street Suite A, Yuma, AZ 85365; 928-317-3220; 928-318-7114; mgibson@blm.gov

D. PERIOD OF PERFORMANCE

The period of performance covered by this contract, will be one (1) base year and four (4) option years. The total duration of this contract shall not exceed five (5) years.

Removal of sewage will begin upon award of the contract and a kick-off meeting shall be scheduled within thirty (30) days or sooner, after award of the contract. Notification of any necessary contract extension must be requested and approved by the BLM Contracting Officer.

Definitions

1. Sewage: liquid, semi-liquid, and solid waste matter.

2. Debris: all other refuse found in toilet vaults that is not defined in #1 above.

3. Effluent Filter: device located at the outlet end of septic tanks to stop the flow of solids larger than 1/8" from entering the effluent stream.

4. Basis of Payment: Payment coincides with flat rate per visit for itemized location identified on spreadsheet in Section H on page 8.

E. GENERAL REQUIREMENTS

1. The Contractor shall furnish toilet pumping services which include all equipment, supervision, transportation, labor, operating supplies, and incidentals necessary to pump, recharge, clean, disinfect, and dispose of all waste products removed from the vault toilets, septic tanks, and combination vault and pumping installations. All work performed under this contract shall be in accordance with the following contract specifications and in accordance with county, State and Federal regulations. The awarded vendor shall provide pumping service for removal of sanitary waste, sludge and any other foreign matter including but not limited to: bottles, cans, clothing, rocks, boards, etc. from the devices at the requested site(s) at the bid price listed in the pricing documents.

2. The Recipient shall provide all transportation, meals, and lodging for himself/herself and his/her personnel as well as all equipment necessary to complete the work. It is not anticipated that any government furnished equipment will be required. All equipment is subject to the inspection by and approval of the YFO Safety Officer and regulatory personnel.

3. Emergencies are line items in Section H, as a flat fee for each site in that an emergency may occur. Scheduling for the additional services is to be done on a reasonable basis. Emergencies may need to be expedited, and subject to availability. Other service providers may be used. This contract may not be subcontracted.

4. During the pre-work conference the Recipient shall provide the CO (via the COR) the names of personnel being considered for work under this contract. The Recipient shall not replace or substitute any staff member without prior written approval by the COR.

5. The Contractor is responsible for their own equipment maintenance and accountability in order to comply with the contract. If the Contractor is unable to fulfill their contractual obligations he/she must immediately contact the COR.

6. Gates have been installed on various roads. When closed, they are not to be ignored or circumvented for any reason. If contract work is required behind a locked gate, contact the COR and/or PI.

7. All parties involved in this contract agree to comply with all applicable laws and regulations pertaining to the provision of safe and respectful workplace and to provide a work environment free of harassment and intimidation for such party’s own employees and third parties.

8. All work conducted in support of this contract shall comply with all Federal laws applicable to public and State lands including, but not limited to: 2010 YFO Resource Management Plan (RMP), Endangered Species Act, the Clean Water Act and the Migratory Bird Treaty Act.

9. Vehicle operators may not use cell phones unless the vehicle is safely stopped. Drivers may not hold, dial, text or adjust the phone while the vehicle is in motion.

10. No ground disturbing activities are to take place without the concurrence from the COR. Under no circumstances shall the Recipient violate the Archeological Resources Protection Act. If any objects are found that appear to be cultural or archeological resources, contact the COR. If the Recipient accidentally disturbs an archeological and/or cultural resources site, the Recipient shall leave the site immediately (as intact as possible) and immediately contact the COR.

11. The Recipient shall manage generated hazardous material, hazardous waste, and hazardous waste residues in accordance with Federal, State, and Local regulations. Transport and dispose of hazardous waste in accordance with Federal, State, and Local regulations.

12. The Recipient shall inform the COR and PI via e-mail of any unusual animal or plant species observed in and around pumping sites. Information should include (a) location, (b) date, (c) time and (d) any detailed facts from the sighting.

13. The Contractor and his employees shall make every reasonable effort to prevent interference with the normal use and occupancy of recreational areas while engaged in the performance of the contract. If pumping or other associated work is not being done under the parameters of this contract, contract personnel and equipment are not permitted within the management areas.

14. The Vendor shall provide and utilize Personal Protective Equipment (PPE) for their employees at all times as appropriate. PPE includes but is not limited to substantial footwear, eye and face protection, hearing protection, and gloves.

15. Due to the nature of work performed under this contract, the Contractor and his employees shall keep themselves and their equipment presentable at all times. The COR may, in writing, require the Contractor to remove from the work site any employee the COR deems incompetent, careless, discourteous to the public, or is otherwise found objectionable. Other grounds for removal include theft, possession and/or removal of materials, supplies, equipment, or any Government-owned property.

16. The Contractor is required to provide a Hazardous Material Spill Response Plan within 30 days of contract award. A draft would be provided at the pre-work conference, and a final provided to the COR within 45 days of contract award.

F. SPECIFIC REQUIREMENTS

Equipment The Contractor shall furnish all sewage pumping equipment, tank truck, water truck, tools, approved disinfectant, and other equipment and supplies necessary to perform work in accordance with these specifications. Four-inch (minimum size) suction hose and attachment couplings shall be utilized to accomplish all pumping requirements. The length of hose must be sufficient enough to accomplish the required pumping.

A washer system (pressure preferred) is required to wash the area after pumping if spillage occurs. Additionally, it may be necessary to dilute solidified waste in the bottom of a flat-bottomed vault and to wash the last portion of waste down a slope bottomed vault.

Water drafting equipment (if necessary to get water from a lake, pond, or stream) shall consist of pumps, tanks, hoses, etc. and shall be completely separate from toilet waste pumping and hauling equipment.

All equipment shall be in full accordance with all applicable Federal, State, County and Local Regulations.

Outside Manhole pumping procedures

Vault toilets: When the exterior pump-out access is in excess of 20 inches in diameter or 20 inches square the Contractor shall not be allowed to remove the vault contents through the toilet riser.

All debris removed from the vault shall be placed into a leak proof container so that no contamination to the surrounding ground shall result.

Flat bottom type vault: The waste shall be removed to within 4 to 5 inches of the bottom. Remove any further debris that was not removed during the initial raking and removal. Wash down all interior walls of the vault. If at this time there is still a heavy concentration of solids on the bottom of the vault, then all solids shall be broke up and diluted and then pumped down to the 4 to 5 inch level. Compacting the waste material in the bottom of the vault to obtain the 4 to 5 inch depth shall not be allowed. After the sewage removal is completed, the vault shall be recharged with water to a minimum depth of 10 inches.

Sloped bottom type vault: Remove all waste and debris. Wash down all vault walls. Pump out all remaining waste and water. Recharge the vault with water so that there is a minimum of 10 inches of water covering the bottom under the toilet riser.

All contaminated areas resulting from the pumping process shall be cleaned up and disinfected. Sweep or wash all waste that is deposited on the concrete surrounding the manhole cover, back into the vault. All waste that runs off onto the dirt or gravel shall be diluted or picked up so not to cause a potential health risk and odor problem.

Clean thoroughly around the manhole cover gasket area and replace the cover. The manhole cover MUST fit with an airtight seal so that the venting process of the vault toilet is not interfered with. If there is not an airtight seal, the Contractor shall notify the COR.

Pumping procedures through the Toilet Riser

Only when the availability of an outside manhole is non-existent, will the Contractor remove the toilet riser prior to pumping or removing debris. The Contractor shall not remove debris or pump through the toilet riser. (without removing the riser.)

Remove the debris and pump, extra care shall be taken to prevent waste spillage onto the interior floor and wall surface while removing debris or pumping. The toilet paper dispensers shall be covered with a waterproof material prior to removing debris or pumping, in order to prevent the paper from becoming contaminated.

During the final cleanup, the interior floor surface and any wall surface that was contaminated by waste shall be thoroughly disinfected. The Contractor shall sweep or wash any spilled waste back into the vault. The Contractor shall not wash or sweep spilled waste out through the front door.

Thoroughly wash and disinfect both the inside and outside of the toilet riser, the seat and cover, before replacing the riser. Remove the waterproof covering over the toilet paper dispenser and make sure that the paper is not contaminated. If the paper is contaminated, the Contractor shall notify the COR.

Each unit shall be available for immediate use after the pumping and final cleanup. The Contractor shall not leave any toilet location until final cleanup is accomplished.

Pumping Procedures for combination Vault / Lift Stations

The sewage lift pumps associated with these installations require removal prior to pumping the vaults and re-installation afterward. All costs associated with this are to be included in the bid price and are not a separate pay item.

Drafting of Water

The Contractor may draft fresh water from lakes, ponds, and streams under the following conditions:

a. Drafting shall be accomplished when it least interferes with the public use of the facility and at areas least viewed by the public.

b. No waste shall be introduced into any body of water.

c. The COR shall approve all sites used for drafting water. The contractor will provide a list of potential drafting locations at the pre-work conference for approval. As part of the weekly correspondence, notification of draft location used will be included.

Offsite Disposal of Sewage and Debris

The Contractor shall be responsible for making off-site disposal arrangements, including disposal of all effluent, debris, trash, and payments of all fees. Use of on-site garbage cans, dumpsters, leach fields, and/or sewage lagoons is not acceptable.

Disposal shall conform to all Federal, State, and Local laws or ordinances. COR shall approve all disposal sites before pumping begins. The contractor will provide a list of potential disposal locations at the pre-work conference for approval. As part of the weekly correspondence, notification of disposal location used will be included.

The Contractor shall be responsible to prevent spillage and to haul all waste material (sewage and debris) in watertight containers. Handling of all waste material shall be in accordance with all applicable health regulations.

Cleaning of Effluent Filters

Filters shall be removed from septic tanks and thoroughly cleaned. The transporting of the filters to the dump stations for cleaning is acceptable. All waste and contaminated material from filter cleaning operations shall be contained for proper disposal.

G. MEETINGS/COORDINATION

1. The Recipient or his/her designee will attend a kick-off meeting with the COR, PI, and relevant regulatory agency personnel within thirty (30) days of award to ensure coordination of activities. The COR/PI shall arrange the meeting.

2. Weekly, the Recipient shall email the COR and COR Alternate, to relay the progress of the Recipient in fulfilling the requirements, specifications, and scope of work. If no work has occurred during the week, email is still required stating no work was conducted. This communication would also be used to facilitate other correspondence to address concerns.

3. The Recipient shall be available throughout the contract period for consultation with the COR and PI on matters involving sewage pumping.

4. Weekly email reports will be sent to the COR to include: pumping services, site visits, communication that takes place with COR, PI or any other BLM personnel. Quarterly financial reports will be submitted to the COR, as well as an annual report of services provided.

5. Prior to the start of work, a Pre-work Conference will be scheduled by the Contracting Officer to be attended by the Contractor, the COR and PI and any other BLM Personnel who may be involved in the administration of this contract. The meeting will be held at a time and place mutually agreeable to the Contractor and COR. The purpose of this meeting is to thoroughly discuss the schedule of work, work performance requirements, approved waste disposal sites, approved water drafting locations, contract terms, and to familiarize both parties with the responsibilities of each under the terms of this contract. The contractor will also provide the COR with a draft Health and Safety Plan and Accident Prevention Plan and Hazardous Material Spill Response Plan that will be finalized within 45 days of the contract award.

H. SCHEDULE AND SUPLIMENTALS

The following includes a description and general location of all sewage pumping locations. Each location has a specified month in which pumping service must be completed. No alterations to this can occur without prior written consent from the COR (email is acceptable).

Quarterly financial reporting will be submitted to the COR. An annual report summarizing all materials utilized, summary of findings, and future recommendations will be reported to the COR by May 31 each year. This report will include specific information for each unit as itemized below to provide the most detailed information.

Annual if added

Annual if added

TBD

TBD

TBD

TBD

TBD

I. SAFETY

The Recipient will be required to develop a site-specific Health and Safety Plan (HASP) and Accident Prevention Plan (APP). Potentially hazardous activities include, but are not limited to:

· All field work in temperatures that exceed 100 degrees

· Soil boring or digging test pits (excludes manual collection of de minimis surface soil samples)

· All field work on hazardous waste or munitions response sites

· Work on, in, or near bodies of water where there a danger from drowning

· Use of heavy equipment, e.g. backhoes, excavators, bulldozers, etc.

· Excavation, backfilling, and compaction

· Use of man lifts, ladders, and other climbing apparatus

· Use of weight handing equipment, e.g. crane, forklifts, and hoists

· Well drilling and/or well pump repair or replacement

· Construction, demolition, or repair of site improvements

· Remediation of hazardous material or waste, i.e. asbestos, paint with lead, and PCB

· Work within 10 ten feet of high voltage lines, or high pressure gas, steam, or water lines

The Recipient shall develop an APP, Activity Hazardous Analysis (AHA) and site-specific HASP in accordance with Occupational Safety and Health Administration (OSHA), and submit the AHA and HASP as attachments to the COR and PI.

Include a job hazard analysis in the HASP for all tasks reasonably anticipated to be performed as part of this scope of work. When developing the HASP, address all sections that are deemed appropriate for performing the work in this contract, while ensuring a safe work environment for all personnel involved.

The Health & Safety Plan will provide a safe and healthful environment for all personnel involved as well as personnel working near the sites for the BLM. The Recipient shall certify to COR that Final HASP has been reviewed with each Recipient employee working on this contract prior to mobilization and start of fieldwork activities.

A Draft and Final APP and HASP will be submitted within 30 days of contract award. The Health and Safety Plan shall be immediately accessible to the Site Safety Officer and Project Manager at all times during the project, and a copy shall be available in every vehicle utilized for work under this contract.

J. HOLD HARMLESS

1. The Government shall not be responsible for the loss of or damage to property of the Recipient and/or his/her representatives, or for personal injuries to the Recipient and/or his/her representatives arising from or incident to the use of government facilities or equipment. Recipient shall indemnify, hold harmless, defend and save Government harmless and shall pay all costs, expenses, and reasonable attorney’s fees for all trial and appellate levels and post-judgment proceedings in connection with any fines, suits, actions, damages, liability and causes of action of every nature whatsoever arising or growing out of, or in any manner connected with, the occupation or use of Government Premises by Recipient, its employees, servants, agents, guests, invitees, and contractors. This includes, but is not limited to, any fines, claims, demands and causes of action of every nature whatsoever that may be made upon, sustained or incurred by the Government by reason of any breach, violation, omission or non-performance of any term, covenant or condition hereof on the part of the Recipient, its employees, servants, agents, guests, invitees, or contractors. This indemnification also applies to claims arising out of the furnishings of any utilities or services by the Government or any interruption therein or failure thereof, occasioned by the negligence or lack of diligence of Recipient or its respective officers, agents, servants or employees. However, this indemnity shall not extend to damages due to the sole fault of the Government or its employees, agents, servants, guests, invitees or contractors. This covenant shall survive the termination of this contract.

2. In the event of damage, including damage by contamination, to any Government property by the Recipient, its officers, agents, servants, employees, or invitees, the Recipient, at the election of the Government, shall promptly repair, replace, or make monetary compensation for the repair or replacement of such property to the satisfaction of the Government.

K. INSURANCE

1. At the commencement of this contract, the Recipient shall obtain, from a reputable insurance company or companies satisfactory to the Government, comprehensive general liability insurance. The insurance shall provide an amount not less than a minimum combined single limit of $1,000,000.00 for any number of persons or claims arising from any one incident with respect to bodily injuries or death resulting therefrom, property damage or both, suffered or alleged to have been suffered by any person or persons resulting from or related to the presence or operations of the Recipient, its employees, agents or Contractors under this contract. The Recipient shall require the insurance company or companies to furnish the Government with a certified copy of the policy or policies, or certificates of insurance evidencing the purchase of such insurance. Each policy of insurance required under this Paragraph shall contain an endorsement reading as follows:

“The insurer waives any right of subrogation against the United States of America which might arise by reason of any payment made under this policy.”

2. All insurance required of the Recipient hereunder shall be in such form, for such periods of time and with such insurers as the Government may require or approve. All policies or certificates issued by the respective insurers for public liability and property insurance shall name the United States of America as an additional insured, and shall provide that no cancellation, reduction in amount or any material change in coverage thereof shall be effective until at least 30 calendar days after receipt by the Government of written notice thereof, regardless of any prior act or failure to act or negligence of the Recipient or the Government or any other person concerning such amount or change in coverage.

3. The Recipient at its sole cost and expense, may insure its activities in connection with this contract by maintaining a program of self-insurance that complies with the requirements of this Section K, including coverages specified in Attachment B hereof. Recipient shall also provide a copy of the exempting statute cited in support of its claim of self-insurance pursuant to Section 2 of Attachment B to this contract. (The self-insurance clause is applicable only to appropriate State and Local governments and qualifying institutions of higher education who provide evidence of a self-insurance program in accordance with this Section and Attachment B, Section 2.)

4. During the entire period the contract shall be in effect, the Recipient shall require its contractors or agents or any contractor performing work at the Recipient’s or agent’s request on the affected Government Premises to carry and maintain the insurance required below:

“Comprehensive general liability insurance in the amount of $1,000,000.00.”

5. The Recipient and any of its Contractors or agents shall deliver or cause to be delivered promptly to the Contracting Officer, a certificate of insurance or a certified copy of each renewal policy evidencing the insurance required by this contract and shall also deliver no later than thirty (30) calendar days prior to expiration of any such policy, a certificate of insurance evidencing each renewal policy covering the same risks.

6. In the event that any item or part of the premises or facilities shall require repair, rebuilding, or replacement resulting from loss or damage, risk of which is assumed under this Section K, the Recipient shall promptly give notice thereof to the Government and, to the extent of its liability as provided in this Section K, shall, upon demand, either compensate the Government for such loss or damage, or rebuild, replace or repair the item or items of the premises or facilities so lost or damaged, as the Government may elect. If the cost of such repair, rebuilding, or replacement exceeds the liability of the Recipient for such loss or damage under this Section K, the Recipient shall effect such repair, rebuilding, or replacement if required so to do by the Government, and such excess of cost shall be reimbursed to the Recipient by the Government. In the event the Recipient shall have effected any repair, rebuilding, or replacement which the Recipient is required to effect pursuant to this Section K, the Government shall direct payment to the Recipient of so much of the proceeds of any insurance carried by the Recipient and made available to the Government on account of loss of or damage to any item or part of the premises or facilities as may be necessary to enable the Recipient to effect such repair, rebuilding or replacement. In event the Recipient shall not have been required to effect such repair, rebuilding, or replacement, and the insurance proceeds allocable to the loss or damage which has created the need for such repair, rebuilding or replacement have been paid to the Recipient, the Recipient shall promptly refund to the Government the amount of such proceeds.

L. PAYMENTS

1. Partial payments equal to the amount of work accomplished may be made quarterly during the field work portion; after submittal of the draft report; and after receipt of the final report.

2. The final payment of 20 percent of the contract overall value shall be paid when the final report and all other submittals listed in Section H have been received and accepted by the COR.

3. Any requirement for the payment or obligation of funds, under the terms of this contract, shall be subject to the availability of appropriated funds, and no provision herein shall be interpreted to require obligation or payment of funds in violation of the Anti-Deficiency Act, 31 USC §1341 et seq. Nothing in this contract shall be construed as implying that Congress will, at a later time, appropriate funds sufficient to meet deficiencies.

ATTACHMENT A: MAPS

ATTACHMENT B

SELF-INSURANCE REQUIREMENTS FORM

INSURANCE MUST CONFORM TO ALL THE REQUIREMENTS LISTED BELOW

PRIOR TO RECIPENT BEING PERMITTED TO USE OR OCCUPY GOVERNMENT PREMISES OR PROPERTY PURSUANT TO THE CONTRACT

1. PUBLIC LIABILITY AND PROPERTY DAMAGE

a. Required minimum amounts of insurance listed below:

$ N/A Fire and Extended Coverage

$ 1,000,000 Third Party Property Damage

$ 1,000,000 Third Party Personal Injury Per Person

$ 1,000,000 Third Party Personal Injury Per Accident

2. SELF-INSURANCE REQUIREMENTS:

If your organization is self-insured, please provide evidence of self-insurance which meets or exceeds the insurance liability amounts in Item # 1.

The following information, written on your organization‘s letterhead, is also required:

3. IF YOUR SELF-INSURANCE PROGRAM DOES NOT MEET THE ABOVE MINIMUM REQUIREMENTS:

Provide evidence of Excess Liability Insurance in the amount necessary to meet or exceed the minimum requirements in Item #1 above.

The following endorsements are required for Excess Liability insurance policies:

a. “The insurer waives any right of subrogation against the United States of America which might arise by reason of any payment made under this policy."

b. "U.S. Bureau of Land Management Yuma Field Office Yuma, AZ shall be given thirty (30) days written notice prior to making any material change in or the cancellation of the self-insurance program."

c. "The United States of America U.S. Bureau of Land Management is added as an additional insured in operations of the policyholder at or from the premises licensed/leased from the United States”.

d. "This insurance certificate is for use of facilities under this contract, No. x#####-##-#-####.

4. NOTICE: "RIGHT TO USE" DOCUMENTS WILL NOT BE FULLY EXECUTED UNTIL CERTIFICATE IS RECEIVED WITH PROPER ENDORSEMENTS.

ATTACHMENT B

INSURANCE REQUIREMENTS FORM

(NON SELF-INSURED)

INSURANCE MUST CONFORM TO ALL THE REQUIREMENTS LISTED BELOW

PRIOR TO RECIPENT BEING PERMITTED TO USE OR OCCUPY GOVERNMENT PREMISES OR PROPERTY PURSUANT TO THE CONTRACT

Your attention is invited to the provisions of the contract pertaining to the items checked below:

X 1. PUBLIC LIABILITY AND PROPERTY DAMAGE:

a. Required minimum amounts of insurance listed below:

$ 1,000,000.00 Third Party Property Damage

$ 1,000,000.00 Third Party Personal Injury Per Person

$ 1,000,000.00 Third Party Personal Injury Per Accident

$ n/a Fire and Extended Coverage

X 2. THE CERTIFICATE OF INSURANCE MUST CONTAIN THE FOLLOWING ENDORSEMENTS:

a. "The insurer waives any right of subrogation against the United States of America which might arise by reason of any payment made under this policy."

b. " U.S. Bureau of Land Management Yuma Field Office Yuma, AZ, shall be given thirty (30) days written notice prior to making any material change in or the cancellation of the policy."

c. "The United States of America (Dept. of the Navy) is added as an additional insured in operations of the policyholder at or from the premises licensed / leased from the United States."

d. " This insurance certificate is for use of facilities under this contract, No. x#####-##-#-####.

e. Loss, if any, under this policy shall be adjusted with the Recipient and the proceeds, at the direction of the Government, shall be payable to the Recipient, and proceeds not paid to Recipient shall be payable to the Treasurer of the United States of America.”

X 3. NOTICE: "RIGHT TO USE" DOCUMENTS WILL NOT BE FULLY EXECUTED UNTIL CERTIFICATE IS RECEIVED WITH PROPER ENDORSEMENTS.

image2.jpeg image3.jpg image1.jpeg