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Private Landowners Draft Benton County Prairie Species HCP Appendix A Appendix A. Draft Certificate of Inclusion Template – Private Landowners 1 Draft Benton County Prairie Species HCP Appendix A BENTON COUNTY PRAIRIE SPECIES HCP CERTIFICATE OF INCLUSION for Private Landowners BENTON COUNTY COMMUNITY DEVELOPMENT DEPARTMENT, 360 SW Avery Avenue, Corvallis, OR The United States Fish and Wildlife Service (“Service”) issued to Benton County (“County”) an Incidental Take Permit (“Permit”) No. _______, on [[[Date]]], for a period of 50 years, pursuant to Section 10(a)(1)(B) of the Endangered Species Act of 1973, as amended, 16 U.S.C. 1539(a)(1)(B). Such Permit authorizes the "Take" of Fender’s blue butterfly and its habitat in accordance with the terms and conditions of the Permit, the Benton County Prairie Species Habitat Conservation Plan ("HCP"), and the associated Implementing Agreement. Under the Permit, [[[insert name of party seeking the certificate of inclusion]]] (“Participating Landowner”) is authorized to perform certain activities covered in the Permit resulting in the "Take" of Fender’s blue butterfly and its habitat, provided all applicable terms and conditions of the Permit, the HCP, and the associated Implementing Agreement are met. As the owner of the property depicted on Exhibit "A", attached hereto and incorporated herein by this reference, you are entitled to the protection of the Permit for the activities authorized by the County in the [[[name of County permit]]], with respect to any Take of Fender’s blue butterfly and its habitat as identified in the HCP. In the event the property depicted on Exhibit "A" is used for other purposes without the express consent of Benton County, Take Authorization under the Permit will automatically cease and the U.S. Fish and Wildlife Service shall be notified of the revocation of the Certificate of Inclusion within 5 business days of such action. Such authorization is provided as described in the Permit, the HCP, and the Implementing Agreement. By signing this Certificate of Inclusion, you signify your election to receive Take Authorization under the County’s Permit in accordance with the terms and conditions thereof and in accordance with the terms and conditions of the Benton County [[[name of County permit]]]. This Certificate of Inclusion does not impose additional regulatory control over the signatory nor require the signatory to provide additional information not called for in the Certificate of Inclusion, but instead ensures compliance with 50 Code of Federal Regulations, section 13.25(d). Coverage under the Permit will become effective upon receipt of the executed Certificate of Inclusion by Benton County and Participating Landowner. In the event the subject property is sold or leased, the buyer or lessee must be informed of these 2 Draft Benton County Prairie Species HCP Appendix A provisions and execute a new Certificate of Inclusion and [[[name of County permit]]]. [[[Name of Private Landowner]]] Date Address Phone [[[Name of Community Development Director]]] Community Development Director , Date Benton County Representative 3 Draft Benton County Prairie Species HCP Appendix B Appendix B. Draft Certificate of Inclusion Template – Cooperators 1 Draft Benton County Prairie Species HCP Appendix B BENTON COUNTY PRAIRIE SPECIES HCP CERTIFICATE OF INCLUSION for Cooperators BENTON COUNTY COMMUNITY DEVELOPMENT DEPARTMENT, 360 SW Avery Avenue, Corvallis, OR The United States Fish and Wildlife Service (USFWS) issued to Benton County (“County”) an Incidental Take Permit (“Permit”) No. _______, on [[[Date]]], for a period of 50 years, pursuant to Section 10(a)(1)(B) of the Endangered Species Act of 1973, as amended, 16 U.S.C. 1539(a)(1)(B). The Oregon Department of Agriculture (“ODA”) entered into an Implementing Agreement with the County and the USFWS on [[[Date]]], for a period of 50 years. The Permit and Implementing Agreement authorizes the "Take" of [[[covered species]]] and its habitat in accordance with the terms and conditions of the Permit, the Benton County Prairie Species Habitat Conservation Plan ("HCP"), and the associated Implementing Agreement. Under the Permit (USFWS) and Implementing Agreement (ODA & USFWS), [[[insert name of Cooperator seeking the certificate of inclusion]]] (“Participating Landowner”) is authorized to perform certain activities covered in the HCP resulting in the "Take" of [[[covered species]]] and its habitat, provided all applicable terms and conditions of the Permit, the HCP, and the associated Implementing Agreement are met. As the owner of the property depicted on Exhibit "A", attached hereto and incorporated herein by this reference, you are entitled to the protection of the Permit for the activities authorized by the County in the [[[(1) name of permit, (2) name of land use approval, or (3) cooperative agreement]]] with respect to any Take of [[[covered species]]] and its habitat as identified in the HCP. In the event the property depicted on Exhibit "A" is used for other purposes without the express consent of Benton County, Take Authorization under the Permit and Implementing Agreement will automatically cease and the USFWS and ODA shall be notified of the revocation of the Certificate of Inclusion within 5 business days of such action. Such authorization is provided as described in the Permit, the HCP, and the Implementing Agreement. By signing this Certificate of Inclusion, you signify your election to receive Take Authorization under the County’s Permit and Implementing Agreement in accordance with the terms and conditions thereof and in accordance with the terms and conditions of the Benton County [[[(1) name of permit, (2) name of land use approval, or (3)cooperative agreement]]]. This Certificate of Inclusion does not impose additional regulatory control over the signatory nor require the signatory to provide additional information not called for in the Certificate of Inclusion, but instead ensures compliance with 50 Code of Federal Regulations, section 13.25(d). Coverage under the Permit will become effective upon receipt of the executed Certificate of Inclusion by Benton County and Participating Landowner. In the event the subject property is sold or leased, the buyer or lessee must be informed of these provisions and execute a new 2 Draft Benton County Prairie Species HCP Appendix B Certificate of Inclusion and [[[(1) name of permit, (2) name of land use approval, or (3)cooperative agreement]]]. [[[Name of Cooperator]]] [[[Cooperator Representative]]] Date Address Phone [[[Name of Benton County Development Director]]] Community Development Director , Date Benton County Representative 3 Draft Benton County Prairie Species HCP Appendix C Appendix C. Draft Cooperative Agreement Template 1 Draft Benton County Prairie Species HCP Appendix C BENTON COUNTY PRAIRIE SPECIES HCP COOPERATIVE AGREEMENT (Between Benton County and HCP Cooperator) BENTON COUNTY COMMUNITY DEVELOPMENT DEPARTMENT, 360 SW Avery Avenue, Corvallis, OR 1. PARTIES AND PURPOSE. This Cooperative Agreement (“Agreement”) is between Benton County (“County”), and [Property owner] (“Cooperator”). This Agreement is intended to set forth the obligations of the Cooperator for [short term restoration or permanent] impacts to [list the covered species here (“Covered Species”)] on land owned by the Cooperator resulting from covered activities performed by the Cooperator. Participation in this Agreement is a prerequisite for obtaining a Certificate of Inclusion from Benton County issued as part of the County’s Prairie Species Habitat Conservation Plan, Incidental Take Permit (Permit #__________________) from the U.S. Fish and Wildlife Service (USFWS), and Implementing Agreement from the USFWS and Oregon Department of Agriculture (ODA). The County’s Incidental Take Permit, Implementing Agreement, Certificate of Inclusion, and this Agreement do not release the Cooperator from the responsibility to avoid “take” of any covered species already occupying the property. This Agreement includes, at a minimum: (1) Map(s) of Cooperator’s property or properties (Exhibit A) showing the following information: a) Property boundaries, b) Area to be impacted by the covered activity (“Impact Area”), c) Location of Covered Species to be impacted by the covered activity, based on a pre- project survey or calculation of nectar species abundance (Documentation attached as Exhibit B), d) For projects requiring mitigation, Prairie Conservation Area where mitigation will be undertaken, including area where Covered Species will be restored, enhanced or augmented; (2) For projects requiring mitigation, Notice of Mitigation Initiation (Reporting Form D); (3) Current Species Survey/Baseline Assessment (Reporting Form C) of site where habitat restoration, enhancement and management activities or mitigation with occur; (4) Effectiveness Monitoring Plan (Attached as Exhibit C); (5) Cooperator and County responsibilities under the Agreement; and (6) Benton County Habitat Conservation Plan (incorporated herein by reference). 2. AFFECTED PROPERTY. The Cooperator owns property identified as [list tax lot information] or milepost [insert milepost information] in Benton County, Oregon (Exhibit A). 3. BASELINE CONDITIONS OF MITIGATION SITE. Cooperators have performed a baseline assessment of the Prairie Conservation Area where mitigation will be performed. This assessment (Reporting Form C), includes a species survey (See HCP Appendix A: Project Site Survey and Reporting Protocols for Plants and Butterfly Habitat) of the Covered
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