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SFN 17726(10-2011) COMPLIANCE AND UTILIZATION
<br /> CERTIFICATION AND AGREEMENT
<br /> (Including:Terms,Conditions,Reservations,and Restrictions)
<br /> A.The Donee agrees that the United States and the State of North Dakota The donation shall be subject to the terms,conditions, reservations,and
<br /> assume no liability for any damages to the property of the donee,or for the restrictions set forth in the Conditional Transfer Document executed by the
<br /> personal injuries,illness,disabilities or death to employees of the donee,any authorized donee representative.
<br /> other person subject to their control or any other person including members
<br /> of the general public,arising from or incident to the property use,processing, F.OTHER TERMS,RESERVATIONS,AND RESTRICTIONS:
<br /> disposition,or any subsequent operation performed upon,exposure to or
<br /> contract with any component,part,constituent,or ingredient of this item,or 1.From the date it receives the property listed hereon and through the
<br /> substance,or material,whether intention or accidental.The Donee agrees period(s)of time the conditions imposed by B and C above remain in effect,
<br /> to hold harmless and indemnify the United States and the State of North the donee shall not sell,trade, lease,lend,bail,cannibalize,encumber,or
<br /> Dakota for any and all costs,judgment,action,debt,liability costs and otherwise dispose of such property,or remove it permanently,for use
<br /> attorney's fees or any other request for monies or any type of relief arising outside the state,without the prior approval of GSA under B.or the state
<br /> from or incident to the transfer,donation,use,processing,disposition,or any agency under C.The proceeds from any sale,trade, lease,loan,bailment,
<br /> subsequent operation performed upon,exposure to or contact with any encumbrance,or other disposal of the property,such action is authorized by
<br /> component,part,constituent,or ingredient of this item,material or GSA or by the state agency,shall be remitted promptly by the donee to GSA
<br /> substance,whether intentional or accidental and the Donee further agrees to or the state agency,as the case may be.
<br /> the following:
<br /> 2. In the event any of the property listed hereon is sold,traded,leased,
<br /> B.FEDERAL CONDITIONS: loaned,bailed,cannibalized,encumbered,or otherwise disposed of by the
<br /> donee from the date it receives the property through the period(s)of time the
<br /> 1.All items of property shall be placed in use for the purpose(s)for which conditions imposed by B.and C.remain in effect,without the prior approval
<br /> acquired within one year of receipt and shall be continued in use for such of GSA or the state agency,the donee,at the option of GSA or the state
<br /> purpose(s)for one year from the date the property was placed in use.In the agency,shall pay to GSA or the state agency,as the case may be,the
<br /> event the property is not so placed in use,or continued in use,the donee proceeds of the disposal or the fair market value or the fair rental value of
<br /> shall immediately notify the state agency and,at the donee's expense,return the property at the time of such disposal,as determined by GSA or the state
<br /> such property to the state agency,or otherwise make the property available agency.
<br /> for transfer or other disposal by the state agency,provided the property is
<br /> still usable as determined by the state agency. 3.If at any time,from the date it receives the property through the period(s)
<br /> of time the conditions imposed by B.and C.remain in effect,any of the
<br /> 2.Such special handling or use limitations as are imposed by General property listed hereon is no longer suitable,usable,or further needed by the
<br /> Services Administration(GSA)on any item(s)of property listed hereon. donee for the purpose(s)for which acquired,the donee shall promptly notify
<br /> the state agency,and shall,as directed by the state agency,return the
<br /> 3.In the event the property is not so used or handled as required by B. 1. property to the state agency,or a department or agency of the United States,
<br /> and 2.above,title and right to the possession of such property shall at the sell or otherwise dispose of the property.The proceeds from any sale shall
<br /> option of GSA revert to the United States of America and upon demand the be remitted promptly by the donee to the state agency.
<br /> donee shall release such property to such person as GSA or its designee
<br /> shall direct. 4.The donee shall make utilization reports to the state agency on the use,
<br /> condition,and location of the property listed hereon,and on other pertinent
<br /> C.CONDITIONS IMPOSED BY THE STATE AGENCY APPLICABLE TO matters as may be required from time to time by the state agency.
<br /> ITEMS WITH A FEDERAL UNIT ACQUISITION COST OF$5,000 OR
<br /> MORE AND PASSENGER MOTOR VEHICLES,REGARDLESS OF 5.At the option of the state agency,the donee may abrogate the conditions
<br /> ACQUISITION COST: set forth in C.and the terms,reservations,and restrictions pertinent thereto
<br /> in D.by payment of an amount as determined by the state agency.
<br /> 1.The property shall be used only for the purpose(s)for which acquired and
<br /> for no other purpose(s). 6.The property acquired by the donee is on an"as is,""where is"
<br /> basis,without warranty of any kind.
<br /> 2.There shall be a period of restriction which will expire after such property
<br /> has been used for the purpose(s)for which acquired for a period of 18 7.Where a donee carries insurance against damages to or loss of property
<br /> months from the date the property is placed in use,except for such items of due to fire or other hazards and where loss of or damage to donated
<br /> major equipment,listed hereon,on which the state agency designates a property with unexpired terms,conditions,reservations,or restrictions
<br /> further period of restriction. occurs,the state agency will be entitled to reimbursement from the donee
<br /> out of the insurance proceeds,of an amount equal to the unamortized
<br /> 3. In the event the property is not used as required by C. 1.and 2.above portion of the fair value or the damages or destroyed donated items.
<br /> and federal restrictions B. 1.and 2.above have expired then title and right to
<br /> the possession of such property shall at the option of the GSA revert to the 8.By signing and submitting this lower tier proposal,the prospective lower
<br /> State of North Dakota and the donee shall release such property to such tier participant,as defined in 41 CFR 105-68,certifies to the best of its
<br /> person as the state agency shall direct. knowledge and belief that it and its principals are not presently debarred,
<br /> suspended,proposed for debarment,declared ineligible,or voluntarily
<br /> D.CONDITIONS IMPOSED BY THE STATE AGENCY APPLICABLE TO excluded from participation in this transaction by any Federal department or
<br /> ITEMS WITH A FEDERAL UNIT ACQUISITION COST OF UNDER$5,000: agency and where the prospective lower tier participant is unable to certify to
<br /> any of the above,such prospective participant shall attach an explanation to
<br /> 1.All of the above certifications,terms and conditions shall apply to items this proposal.
<br /> having an acquisition cost of less than$5,000 except those listed in C.2.
<br /> I CERTIFY this Agency/Organization has been informed of
<br /> 2.The period of restriction on items having an acquisition cost of less than these Terms, Conditions, Reservations,and Restrictions and
<br /> $5,000 shall be 12 months of utilization. agrees to them.
<br /> 3.In the event property is not utilized in accordance with terms and
<br /> conditions imposed by the state agency,title and right to possession of such
<br /> property shall at the option of GSA revert to the State of North Dakota and,
<br /> upon demand,the donee shall return the property to the state agency at the Signature of Administrative Official
<br /> donee's expense.
<br /> E.CONDITIONS APPLICABLE TO THE DONATION OF AIRCRAFT AND Date Donee Organization
<br /> VESSELS(50 FEET OR MORE IN LENGTH)HAVING A FEDERAL UNIT
<br /> ACQUISITION COST OF$5,000 OR MORE,REGARDLESS OF THE
<br /> PURPOSE FOR WHICH ACQUIRED.
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