UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT NUMBER ASSIGNMENT AND INFORMATION FORM SEE INSTRUCTIONS ON NEXT PAGE 1. Submission: 2. Functional Area 3. WBS Project 4. Subproject 5. Real Property Original Number: Number or [3 Revision L7122 Asset class: 6 Case File 9. Capital Asset 7. Submission Date: 8. Project Name: or Land Number. Purchase? . Subproject 12 April 2018 Name: Yes No 10. Description of Project: Voluntary Contribution of Monies for BLM MGNT of Public Lands 1 I. ApplicanWendor?s Name: Oklahoma Oil Gas Association Applicant?s Address: 5801 Broadway Ext, Ste 304, Oklahoma City, OK 73118 Applicant?s Phone Number: 12. Organization Code of Lead Of?ce Cost Center: LLNM00400 13. Cost Centers of Other Of?ces Charging to the Project/Subproject: LLNM920000 I 14a. Estimated Start 14b. Estimated 15. Estimated 16. Estimated Actual Date: Completion Date: Project Total Cost: Authority on State Reimbursable: 1 1/27/2018 10/31/2018 $130,000 17. Project Manager?s Name: Shelia Mallory Project Manager?s Phone Number: 505-954-2134 Project Manager?s Organization Code: LLNM920000 Field Of?ce Contact: Carlyn Russell Field Of?ce Phone Number: 405-579-7170 TRUST FUND PROJECTS (Program 7122) MAY BE AUTHORIZED AN INDIRECT COST RATE OTHER THAN THE ANNUAL PREVAILING RATE 18. Exception Indirect Cost 0 000/ 19. Under the Per In-Direct . 0 - Rate: authority of: 20. Approving Of?cer?s Name Aden Seidlitz Print): . (A 21. Approving Of?cer?s Signature: ?r pm. 1 22. Title: I New Mexico State Directol- I Date: FOR BUSINESS CENTER 00612 USE ONLY PROJ El Sales 23. Tables. DEFINITION El WBS Order DI-1040 24. Customer Number: 25. Agreement Number: 26. Sales Order Document Number: 27. Property Asset Reviewed Date: I by: Input by: 28. Retained by: Requesting Of?ce, StatefWashington Of?ce Budget, National Operation Center FORM 1310-20 BLM MOA MEMORANDUM OF AGREEMENT Between: UNITED STATES DEPARTMENT OF INTERIOR Bureau of Land Management; New Mexico State Of?ce, Oklahoma Field Of?ce, and the Oklahoma Oil and Gas Association Regarding Voluntary Contribution or Donation of Money for Bureau of Land Management of Public Lands 1. Purpose: This Memorandum of Agreement (Agreement) is made as of November 1, 2017 (the ?Effective Date?) and outlines an agreement between the United States, Department of the Interior, Bureau of Land Management (BLM), New Mexico State Office, Norman, OK eld Office, concerning the Oklahoma Oil and Gas Association's (OKOGA) voluntary contr button or donation of money for BLM management of public 2. Authority: Section 307M of the Federal Land Policy and Management Act of 1976 (43 U.S.C. 1737M. 3. Responsibilities: 3. shall: i. Voluntarily donate or contribute $130,000 annually, in quarterly increment, (the "Donations?), to the Norman Field Of?ce beginning on the Effec ive Date. ii. At a later date, additional voluntary donations may be made to support the Norman Field Office as designated by OKOGA. Submit a completed DI 3680 form for each Donation. b. Norman Field Office shall: i. Accept the Donations from OKOGA and use them solely to enhance the BLM's resources that are necessary to complete aspects of oil and gas 1 ii. ill. vi. vii. Develop process to improve archeological reviews for oil and gas projects. Monitor the expenditure of funds to ensure that the dollar commitment by OKOGA is not exceeded. Ensure and acknowledge that any Donation meets the donation acceptance criteria in 374 CM 6, paragraph 6.6. Other than covenant to use the funds for the intended purpose specified in Section above, this Agreement does not entitle any person to selection or priority of service. OKOGA understands and agrees that the BLM is responsible for workload assignments, prioritization and resource President Nothing contained in this Agreement is intended to create any right or benefit, substantive or procedural, by any third party against the United States, its agencies, its officers, or any person. ix. Nothing in this Agreement obligates the United States to any current or future expenditure of resources in advance of the availability of appropriation from Congress. Either party may terminate this Agreement by prowding the other ninety (90) days written notice prior to the expirat on of the initial term or the term of any subsequent renewal of the Agreement, at the following addresses 1 OKOGA, Attn Chad Presrdent 5801 BroadWay Extensaon Hwy #304, Oklahoma City, OK 73118 2. SIM, Attn: Sheila Mallory, Deputy State Director of Minerals, 301 Dinosaur Trail, Santa Fe, NM 87508 if this Agreement is terminated prior to the expiration of Its term donated funds wrli remain BLM, but used in accord With Section above xii. This Agreement shall commence as of the Effective Date and shall contm ue for a term of one i 1) year Thereafter, the Agreement shall continue In succeste one year terms unless terminated according to the terms of th IS Agreement. APPROVED: Aden Seidll 2 Date Acting State rector Department of the in erior Bureau of Land Management 301 Dinosaur Trail Santa re, NM 87508 Chad Warmington, Date Oklahoma Oil and Gas Association (OKOGA) 5801 Broadway Extension #304 Oklahoma City, OK 73118 BLM Checklist to Determine Appropriateness of Donation DONATION INFORMATION Prospective Donor Name: git Gas Amountiue of angtion: 51,10,000 Type gt Donatigu; [x JMoneyIContributed Funding ]ReaiProperty Personal Property ]Services ]Products Web? an ad LM ACCEPTANCE FACTORS FOR CONSIDERATION Category: Maintaining the integrity of the Department's and BLM's No Yes or programs and operations (Appropriate) Marb?' (Not Appropriate) 1. Does self-certification by the donor - for donations valued at $25.000 or more - reveal any questions or concerns that would make acceptance of this donation questionable? 2. is the donation. or does the donation appear to be. an attempt to in?uence regulatory or other Departmental or BLM authority? 3. Does the donation fail to meet a legitimate Departmental or BLM need? it 4. Does the donation require a funding commitment that is not currently available or anticipated? 5. Does the donation tail to promote and enhance the BLM's mission, an individual program. or unit? it 6. Does the donation circumvent law. regulation. or policy? 7. is the BLM likely to have di?icuity properly using or managing any No NIA YesiMaybe donated real property (including land or land interests) or personal property within policy. programmatic, and management goals? it 8. Are any conditions on the donation inconsistent with authorized purposes or any relevant BLM policy or planning documents? 9. Will the donation be used by the donor to state or imply endorsement or promotion by the Department or the BLM of the donor or the donor's product or services? 10. Does the donation consist of personnel or funding to hire new or additional permanent BLM employees?? Category: Maintaining the impartiality and appearance of impartiality of i No Yes or 1 Departmental and BLM employees (Appropriate) Maybe" 1. Does the amount of the proposed donation appear to in?uence any pending Departmental or BLM decision or action involving the donor's interests? 2. is there either an actual or an implied commitment by the Department or BLM to take an action favorable to the donor in exchange for the a donation? 3. is the donor (or its officers or directors) involved in litigation or other ?h disputes with the Departrnent. BLM. or other Departmental bureaus or .1: offices? 4. is the donor seeking a permit. license. or other approval from the - 1 1 5. is the donor otherwise engaged in any type of business relationship with the It 6. Will the donor obtain. or appear to obtain. preferential treatment in 55? dealing with the Department or Category: Maintaining public confidence in the Departrnent and BLM. its Fm Fem?- 753 or programs. and its personnel (Appropriate) Maybe? 1 . Would accepting the donation be likely to cause substantial public 1 controversy? i 2. Does the donation consist of goods or services not needed by the r" - I 3. Are any conditions on the donation inconsistent with ELM policy. goals. or 4h programs? a4? i 'Atiach an explanation for any 'yes' or 'rnaybe' responses. A ?yes' or ?rnaybe" response to any of the factors for consideration may not individually trigger a decision to decline a proposed donation. but each illustrates what Authorized Employees must ask when evaluating the totality of circumstances and making donation-related decisions. Authorized "Charging time for existing employees to donated hrnding accounts may be appropriate in some circumstances. The donation. whether for personnel or funding to hire personnel. must be structured such that the donated or funded personnel do not in?uence Departmental or 8th regulatory actions or decidena. AUTHORIZED EMPLOYEE Completed Br. Print a. of BLM Authorized Employee Signature: WW: 4 6? Zr) 8 BLM Authorized Employee Data 4:!ij 0/050 Receipt Page 1 of 1 United States Department of the Interior . Bureau of Land Management R?m?i'F?t OKLAHOMA FIELD OFFICE 201 STEPHENSON PARKWAY NORMAN, OK 73072 No: 4024449 Phone: (405) 579-7100 Transaction 4135281 Date of Transaction: 11/27/2017 CUSTOMER: OKLAHOMA OIL GAS ASSOCIATION 5801 BROADWAY EXT STE 304 OKLAHOMA CITY 73118-7484 US LINE I UNIT . QTY DESCRIPTION REMARKS PRICE TOTAL SUSPENSE, MISCELLANEOUS BLM MO A NM- 32500 00 32500 00 920-2018?002 1 1.00 SUSPENSE: TOTAL: $32,500.00 TEMPORARY HOLD (1 WEEK ONLY) PAYMENT INFORMATION I I AMOUNT. "32500 00 I I TYPE: IICHECK II RECEIVED. Il 1/27/2017 I CHECK NO: I2 22432 NAME: OKLAHOMA OIL GAS ASSOCIATION 5301 BROADWAY EXT STE 304 CITY OK 731 18- 7434 US REMARKS T, This receipt was generated by the automated BLM Collections and Billing System and Is a paper representation of a portion of the of?cial electronic record contained therein. 1 1/27/2017 - . Page of I United States Department of the Interior Bureau Of Land Management BRANCH OF SUPPORT 30 DINOSAUR TRAIL SANTA FL, NM 87508 No: 4075980 Phone: (505) 954-2098 Transaction 4 I 87890 Date of Transaction: 0l/30/2018 1 OKLAI IOMA OIL GAS ASSOCIATION 580] BROADWAY STE 304 OKLAHOMA CITY.OK 73] l8-7484 US LINE UNIT QTY DESCRIPTION REMARKS PRICE TOTAL SUSPENSE. MISCELLANEOUS ISUSPENSE, I 1.00 MISCELLANEOUS TEMPORARY HOLD (1 - n/a 32500.00 ONLY) TOTAL: $32,500.00 PAYMENT INFORMATION I AMOUNT: 32500.00 l01/24/2018 TYPE: CHECK RECEIVED: 01/29/2013 CHECK NEI 22493 NAME: OKLAHOMA OIL GAS ASSOC. 580] BROADWAY EXT STE 304 OKLAHOMA CITY OK 731 18-7484 US REMARKS This receipt was generated by the automated BLM Collections and Billing System and is a paper representation Ofa portion of the Of?cial electronic record contained therein. 1/30/20 I 8 U.S. Department of the interior Dl-3680 Donor Codi?cation Form OMB Control No. l090-0009 expires: i r? Thank you for your interest in making a donation to the Department of the Interior or one of its bureaus (Bureau of Land Management, Bureau of Reclamation, Bureau of Indian Affairs, Bureau of Ocean Energy Management, Bureau of Safety and Environmental Enforcement, National Park Service, Of?ce of Surface Mining, U.S. Fish and Wildlife Service, and U.S. Geological Survey, or other Departmental bureau). it is lnterior's policy to ensure that in accepting donations, the Department maintains its integrity and impartiality, and the con?dence of the public. The following certi?cation helps the Department and you, the potential donor, to identify areas of concern that might be raised by a donation. An af?rmative answer to any of the statements below does not mean a donation will he declined, but may initiate ?thlter review. I am executing this Donor Certi?cation Form as an individual or on behalf of the following organization or person; Oklahoma (mi - . To the best of my owledge and belief, i certify that: i. i am I am not involved in litigation or other controversy with the Department or its bureaus. 2. mam! am not seeking or otherwise engaged in any type of ?nancial or business relationship with the Department, for example, a contract, permit, lease, grant, or cooperative agreement. Federal government agency. 4. This donation is i \/is not expected to be involved with marketing or advertising. 5. I /am/ am not seeking to attach condition(s) to this donation. 6. This donation is I is not part of a series of donations to the Department or its bureaus. For any af?rmative answers above, please attach explanations. Please also identify any other circumstances not addressed in the above questions that may affect the Department?s decision to Chad Warmth Dat and (Sag. Eat 'pn dined @0K064.60m 'zat' . E-n ait ad rgcaanl'aa'?im City OK vans ais- ?33 ~574r City . State . Zip Daytime or Work Phone