U.S. Department of the Interior
Bureau of Ocean Energy Management
OMB Control No.: 1010-0006
Expiration Date: 1/31/2023
Lease
No.
ASSIGNMENT OF OPERATING RIGHTS INTEREST IN
FEDERAL OCS OIL AND GAS LEASE
Lease Effective Date
Part A: Assignment
Legal description of the Operating Rights being assigned:
Assignor(s) does (do) 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):
The approval of this assignment is restricted to operating rights only. This assignment does not
affect record title interest.
Exhibit “A,” 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
This Assignment of Operating Rights Interest has been filed as of the date stamped on this document and is
hereby approved by the Bureau of Ocean Energy Management on the date shown below.
B
y
Authorized Official for BOEM Title
BOEM 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 leasing and lease operations. The BOEM uses the information to track ownership of leases in the Federal OCS. Responses are
required to obtain or retain a benefit. Proprietary data are covered under Section 26 of the OCSLA, 30 CFR 556.10, and in accordance with regulations in 30
CFR parts 550, 551, and 552. 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. Comments on the burden estimate or any other aspect of this form should
be directed to the Information Collection Clearance Office, Bureau of Ocean Energy Management, 45600 Woodland Road, Sterling, VA 20166.
BOEM-0151 (January 2020) Previous Editions are Obsolete.
Page 1 of 2
Assignor(s): Percentage Interest Conveyed
Assignee(s): Percentage Interest Received
Part B Certification and Acceptance
1. Each Assignor certifies it is the owner of the operating rights interest in the above-described lease that is hereby assigned to the Assignee(s) specified above.
2. DEBARMENT COMPLIANCE: Each Assignor and Assignee certifies its compliance with the Department of the Interior’s nonprocurement debarment and
suspension regulations at 2 CFR Subtitle B, Part 1400, and agrees to communicate the requirement to comply with these regulations to persons with whom it does
business related to this operating rights interest assignment by including the terms of the regulations in its contracts and transactions.
3. EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION COMPLIANCE CERTIFICATION: Each Assignor and Assignee certifies that it is 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.
4. QUALIFICATIONS of ASSIGNOR(S) and ASSIGNEE(S): Each Assignor and Assignee certifies that it: is established and officially recognized by the
Bureau of Ocean Energy Management as qualified and authorized to bid on, acquire interests in, and hold OCS oil and gas leases; is exercising and meeting
due diligence requirements on any other OCS lease in accordance with section 8 of the OCSLA, as amended (43 U.S.C. 1337(d)); is in good standing with
acceptable operating performance as required by 30 CFR §§ 550 and 556; is not disqualified by BOEM from acquiring any new OCS leases or assigned interest(s)
in existing leases because of unacceptable operating performance on any other OCS lease; is not failing to meet or exercise due diligence (as determined by
BOEM after notice and opportunity for a hearing under 30 CFR part 590, subpart A); and is not restricted from bidding or acquiring interests in the lease or
officially designated subdivision, therein, or grouped with any other entities on the restricted joint bidders list.
5. Assignee’s execution of this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described
herein. Applicable terms and conditions include, but are not limited to, an obligation to conduct all operations on the leasehold in accordance with the terms and
conditions of the lease, to condition all wells for proper abandonment, to restore the leased lands upon completion of any operations as described in the lease, and to
furnish and maintain bond(s) pursuant to regulations at 30 CFR §§ 550 and 556. 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 (are) subject to, and shall 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 §§ 550 through 556.
This Assignment of Operating Rights Interest will be made effective between the parties hereto as of
Bureau of Ocean Energy Management, United States Department of the Interior.
, upon approval by the
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.
By signing this document, you certify that your statements made herein are true, complete and correct to the best of your knowledge and belief and
are 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.
BOEM-0151 (January 2020) Previous Editions are Obsolete.
Page 2 of 2
Assignor Name: ___________________________________________
Assignor Qualification No. __________________________________
By:
_____________________________________________________
Signatory Name: _________________________________________
Signatory Title: ___________________________________________
Execution Date: ________________________
Assignee Name: ___________________________________________
Assignee Qualification No. __________________________________
By: ______________________________________________________
Signatory Name: __________________________________________
Signatory Title: ____________________________________________
Execution Date: ________________________
Assignor Name: ___________________________________________
Assignor Qualification No. __________________________________
By: _____________________________________________________
Signatory Name: _________________________________________
Signatory Title: ___________________________________________
Execution Date: ________________________
Assign
ee Name: ___________________________________________
Assignee Qualification No. __________________________________
By: ______________________________________________________
Signatory Name: __________________________________________
Signatory Title: ____________________________________________
Execution Date: ________________________