Fillable EMERGENCY FACILITIES & LAND USE AGREEMENT (National Wildfire Coordinating Group)

Fill Online, Printable, Fillable, Blank EMERGENCY FACILITIES & LAND USE AGREEMENT (National Wildfire Coordinating Group) Form

Use Fill to complete blank online NATIONAL WILDFIRE COORDINATING GROUP (NWCG) (ID) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

EMERGENCY FACILITIES & LAND USE AGREEMENT (National Wildfire Coordinating Group)

On average this form takes 23 minutes to complete

The EMERGENCY FACILITIES & LAND USE AGREEMENT (National Wildfire Coordinating Group) form is 3 pages long and contains:

  • 0 signatures
  • 26 check-boxes
  • 78 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Wildfire Coordinating Group (NWCG)

BROWSE NATIONAL WILDFIRE COORDINATING GROUP (NWCG) (ID) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
EMERGENCY FACILITIES & LAND USE AGREEMENT
INCIDENT AGENCY (name, address, phone number)
AGREEMENT NUMBER MUST APPEAR ON ALL PAPERS
RELATING TO THIS AGREEMENT
AGREEMENT NUMBER: ______
EFFECTIVE DATES
a. beginning:
b. ending:
OWNER (name, address, phone number-include day/night/cell)
POINT OF CONTACT (if applicable):
EMAIL:
PAYMENT ADDRESS: Same as above, or
DUNS:
REGISTERED IN SAM.GOV: Yes or No, Vendor Code
Information Worksheet attached
EIN/SSN (only if not in SAM):
County: State: Township: Range: Section:
INCIDENT NAME: ______________________________
INCIDENT NUMBER: ____________________________
RESOURCE ORDER NUMBER: S-_________________
MODIFICATION No/DATE: ___________________
MODIFICATION CO Initials: __________________
TYPE OF CONTRACTOR ("X" APPROPRIATE BOXES):
SMALL BUSINESS LARGE BUSINESS SMALL DISADVANTAGED OWNED WOMEN OWNED HUBZONE
SERVICE DISABLED VETERAN PUBLIC ENTITY GOVERNMENT OTHER
The owner of the property described herein, or the duly appointed representative of the owner, agrees to furnish the
land/facilities for use as .
DESCRIPTION OF LAND/FACILITIES: Address or specific location. If street or highway address is unavailable, use distance
from nearest city, crossroads, or other significant landmark. The local description of how to get to the land/facilities is also
acceptable. (attach separate sheet if more space is necessary)
RATE: For each day that the land/facilities are used, the Government will pay the rate of or as indicated below. Ordinary
wear and tear is included in the rate. The minimum amount guaranteed to be paid under this agreement shall be $ ,
regardless of the length of use. The maximum amount to be paid under this agreement shall not exceed $ . Payment shall
be in accordance with the incident Agency payment procedures.
Rate breakout: _______________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
UTILITIES AND SERVICES:
The above rate includes utility charges for the following: DIESEL GAS ELECTRICITY WATER TOILET
SUPPLIES JANITORIAL SERVICES & SUPPLIES TRASH REMOVAL SEPTIC SERVICE EXISTING
TELECOMMUNICATIONS
The above rate excludes utility charges. The Government will pay to the owner the sum determined due by the Contracting
Officer based on: .
PMS 902-2 (3/18) 1 of 3
Agreement No:
RESTORATION: Restoration beyond ordinary wear and tear. (check only one)
The above sum includes Government restoration of land/facilities. Restoration shall be performed to the extent reasonably
practical. Restoration work includes: .
The above sum excludes restoration of land/facilities. Reasonable costs incurred by the owner (beyond ordinary wear and
tear) in restoring land/facilities to their prior condition shall be submitted, in writing, to the Contracting Officer.
ALTERATIONS: The Government may make alterations, attach fixtures or signs, erect temporary structures in or upon the
land/facilities, install temporary culverts, trenching for utilities, which shall be the property of the Government. Alterations will be
removed by the Government after the termination of the emergency use, unless otherwise agreed.
ORAL STATEMENTS: Oral statements or commitments supplementary or contrary to any provisions of this Agreement shall
not be considered as modifying or affecting the provisions of this Agreement.
ORDINARY WEAR AND TEAR: Ordinary wear and tear is based on the customary use of the land/facilities, and not the use
resulting from the incident.
CONDITION REPORTS: A joint pre and post-use physical inspection report of the land/facilities shall be made and signed by
the parties; the purpose of the inspections shall be to reflect the existing site condition.
OTHER: Describe in detail: .
TERMS AND CONDITIONS: See attachment.
INSURANCE/ INDEMINIFCATION: The United States Federal Government is self-insured and does not have the authority to
indemnify and hold harmless the , from any and all claims, liabilities, losses, damages, charges, etc. The does not
have the authority to indemnify and hold harmless the United States Federal Government from any and all claims, liabilities,
losses, damages, charges etc. The will be responsible for errors, omissions and negligence of its employees. The United
States Federal Government will be responsible for errors, omissions and negligence of its employees to the extent provided by
Congress under the Federal Tort Claims Act [28 U.S.C. 1346(b), 2401(b), 2671-2680, as amended by P.L. 89-506, 80-Stat.
306].
CHECKLIST(s): See attachment. Fill in the following drawing showing the land/facilities under agreement. Include buildings,
roads, paved areas, utility lines, fences, ditches, landscaping and any other physical features which help describe the area.
FEDERAL ACQUISITION REGULATION CLAUSES:
FAR 52.252-2 Clauses Incorporated by Reference (FEB 1998)
This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text.
Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed
electronically at this/these address(es): www.arnet.gov/far/ or www.usda.gov/procurement/policy/agar.html
FAR 52.213-4 Terms and Conditions -- Simplified Acquisitions (Other Than Commercial Items) (NOV 2017)
FAR 52.222-3 Convict Labor (June 2003)
FAR 52.232-1 Payments (APR 1984)
FAR 52.232-11 Extras (APR 1984)
FAR 52.232-17 Interest (MAY 2014)
FAR 52.232-25 Prompt Payment (JAN 2017)
FAR 52-233-1 Disputes (MAY 2014) ALT I (DEC 1991)
FAR 52.243-1 Changes—Fixed Price (AUG 1987)ALT I(APR 1984)
FAR 52.249-4 Termination for the Convenience of the Government (Services)(Short Form)(APR 1984)
FAR 52.249-8 Termination for Default (Fixed-Price Supply and Service)(APR 1984)
Loss, Damage or Destruction: The Government will assume liability for the loss, damage, or destruction of facilities furnished
under this Agreement, provided that no reimbursement will be made for loss, damage, or destruction when due to (1) ordinary
wear and tear, or (2) the fault or negligence of the owner or the owner’s agent(s).
OWNER / OWNER’S AGENT SIGNATURE:
CONTRACTING OFFICER'S SIGNATURE:
DATE:
PRINT NAME AND TITLE:
PHONE NUMBER:
EMAIL:
PRINT NAME AND TITLE:
PHONE NUMBER:
EMAIL:
PMS 902-2 (3/18) 2 of 3
Agreement No:
ATTACHMENT 1
PRE-USE INSPECTION: Description or photos/ condition immediately prior the Government’s occupancy. Refer to attached
checklist.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
OWNER / OWNER’S AGENT SIGNATURE:
DATE:
GOVERNMENT AGENT/ EMPLOYEE’S
SIGNATURE:
DATE:
PRINT NAME AND TITLE:
PRINT NAME AND TITLE:
POST-USE INSPECTION: Description of photos/ condition immediately following the Government’s occupancy.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
NO DAMAGE NO CLAIMS
TOTAL AMOUNT DUE $________
RELEASE OF CLAIMS STATEMENT: Contract release for and in consideration of receipt of payment in the amount shown in ‘total amount
due’. Contractor hereby releases the Government from any and all claims arising under this agreement except as reserved in remarks.
REMARKS:
OWNER / OWNER’S AGENT SIGNATURE:
DATE:
GOVERNMENT AGENT/ EMPLOYEE’S
SIGNATURE:
DATE:
PRINT NAME AND TITLE:
PRINT NAME AND TITLE:
PMS 902-2 (3/18) 3 of 3
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

EMERGENCY FACILITIES & LAND USE AGREEMENT (National Wildfire Coordinating Group)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document