FS-2700-4-Shawnee Special Use Permit for Equestrian Outfitting in the Shaw

Use Code: 153
Authorization ID: #AUTH_ID#
Contact Name: #HOLDER_ID#
Expiration Date: #EXPIRATION_DATE#

FS-2700-4 Shawnee (XX/202X)
OMB No. 0596-0082

U.S. DEPARTMENT OF AGRICULTURE
Forest Service, Eastern Region
SPECIAL USE PERMIT FOR
EQUESTRIAN OUTFITTING IN THE SHAWNEE NATIONAL FOREST
AUTHORITY:
FEDERAL LANDS RECREATION ENHANCEMENT ACT, 16 U.S.C. 6802(h), and
R9 Shawnee 2709.11-2006-1

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[Enter name] CAMPGROUND [enter city, state, and zip code] hereinafter called the holder, is hereby
authorized to use and occupy Shawnee National Forest System lands, subject to the terms and
conditions of this permit, to provide outfitting/guiding services from the holder’s campground to the
Shawnee National Forest, as shown on the map of the authorized area attached to this permit.
This permit is a temporary use permit issued for the purpose of authorizing the following activities:
equestrian outfitting/guiding services.
This use will be exercised as described in the annual operating plan which is hereby incorporated in this
permit.
TERMS AND CONDITIONS

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1. Use under this permit shall begin on ___________end on ___________. The permit shall not be
extended except by the authorized officer.

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2. A flat fee shall be assessed annually for this use at the rate of $0.89 per service day or Option B
(attached). The minimum fee for this use is $_________ per year. The annual fee for this use shall be
paid in advance and is not refundable. The holder shall provide documentation of use and revenue for
purposes of permit fee verification. This authorization shall terminate upon the holder’s failure to make the
annual fee payment, late payment charge, and any other charges when due.
3. The holder shall make the accounting books and supporting records for the business activities
authorized by this permit available for audit by the Forest Service or other federal agencies authorized to
review Forest Service activities. The holder shall retain these records and make them available for review
for five years after the end of the year they were generated, unless disposition is otherwise authorized by
the Forest Service in writing.
4. The annual operating plan, which shall be attached to this permit, shall be submitted by the holder and
approved by the authorized officer before the holder conducts any services authorized by this permit. The
holder shall prepare an annual operating plan by _____________ in consultation with the authorized
officer. At a minimum, the annual operating plan shall include (1) the season of use for authorized
outfitting and guiding activities, including the start and stop date of operations; (2) limitations on use
established by the Forest Service (including fire restrictions); and (3) a completed Estimated Fee
Determination Sheet (which shall be attached to this permit).
5. The holder shall not install any improvements on Shawnee National Forest System land without prior
written approval of the authorized officer.

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6. In exercising the rights and privileges granted by this permit, the holder shall comply with all present
and future federal laws and regulations and all present and future state, county, and municipal laws,
regulations, and other legal requirements that apply to the permit area, to the extent they do not conflict
with federal law, regulation, or policy. The Forest Service assumes no responsibility for enforcing laws,
regulations, and other legal requirements that fall under the jurisdiction of other governmental entities.
7. The holder has an affirmative duty to take reasonable steps to protect from damage the land, property,
and other interests of the United States. Damage includes but is not limited to fire suppression costs,
damage to government-owned improvements covered by this permit, and all costs and damages
associated with or resulting from the release or threatened release of a hazardous material occurring
during or as a result of activities of the holder or the holder's heirs, assigns, agents, employees,
contractors, or lessees on, or related to, the lands, property, and other interests covered by this permit.
"Hazardous material" shall mean any hazardous substance, pollutant, contaminant, hazardous waste, oil,
and/or petroleum product, as those terms are defined under any federal, state, or local law or regulation.

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8. The holder shall avoid damaging or contaminating the environment, including but not limited to the soil,
vegetation (such as trees, shrubs, and grass), surface water, and groundwater, during the holder's use
and occupancy of the permit area. If the environment or any government property covered by this permit
becomes damaged during the holder's use and occupancy of the permit area, the holder shall
immediately repair the damage or replace the damaged items to the satisfaction of the authorized officer
and at no expense to the United States.

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9. The holder shall indemnify, defend, and hold harmless the United States for any costs, damages,
claims, liabilities, and judgments arising from past, present, and future acts or omissions of the holder in
connection with the use and occupancy authorized by this permit. This indemnification and hold harmless
provision includes but is not limited to acts and omissions of the holder or the holder's heirs, assigns,
agents, employees, contractors, or lessees in connection with the use and occupancy authorized by this
permit which result in (1) violations of any laws and regulations which are now or which may in the future
become applicable, including but not limited to applicable environmental laws; (2) judgments, claims,
demands, penalties, or fees assessed against the United States relating to the use and occupancy on
Shawnee National Forest System land under this permit; (3) costs, expenses, and damages incurred by
the United States; or (4) the release or threatened release of any solid waste, hazardous waste,
hazardous substance, pollutant, contaminant, oil in any form, or petroleum product into the environment
relating to the use and occupancy on Shawnee National Forest System land under this permit. The
authorized officer may prescribe terms that allow the holder to replace, repair, restore, or otherwise
undertake necessary curative actions to mitigate damages in addition to or as an alternative to monetary
indemnification.
10. No insurance is required unless the holder provides stock and/or guiding services.

11. If holder provides stock and/or guiding services, the holder shall furnish proof of insurance, such as a
certificate of insurance, to the authorized officer prior to issuance of this permit and each year thereafter
that this permit is in effect. The Forest Service reserves the right to review and approve the insurance
policy prior to issuance. The holder shall send an authenticated copy of any insurance policy obtained
pursuant to this clause to the authorized officer immediately upon issuance of the policy. Any insurance
policies obtained by the holder pursuant to this clause shall name the United States as an additional
insured, and the additional insured provision shall provide for insurance coverage for the United States as
required under this clause. Such policies shall also specify that the insurance company shall give 30 days
prior written notice to the authorized officer of cancellation of or any modification to the policies. The
certificate of insurance, the authenticated copy of the insurance policy, and written notice of cancellation
or modification of insurance policies should be sent to Hidden Springs Ranger Station 602 N. First Street,
Route 45 North, Vienna, Illinois 62995. Minimum amounts of coverage and other insurance requirements
are subject to change at the sole discretion of the authorized officer on the anniversary date of this permit.

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a. The holder shall have in force liability insurance covering losses associated with the use and
occupancy authorized by this permit arising from personal injury or death and third-party property damage
in the minimum amount of $500,000 as a combined single limit per occurrence.
12. The holder agrees at all times to permit the free and unrestricted access to the Shawnee National
Forest System lands covered by this permit for all lawful and proper purposes not inconsistent with the
intent of the permit or with the reasonable exercise and enjoyment by the holder of the privileges thereof.
13. This permit is subject to all valid existing rights and claims of third parties on Shawnee National Forest
System land.

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14. The authorized officer may revoke or suspend this permit in whole or in part (1) for noncompliance
with federal, state, or local laws and regulations; (2) for noncompliance with the terms of this permit; (3)
for failure of the holder to exercise the privileges granted by this permit; (4) with the consent of the holder;
or (5) at the discretion of the authorized officer, for specific and compelling reasons in the public interest.
Prior to revocation or suspension, the authorized officer shall give the holder written notice of the grounds
for the action to be taken. Prior to revocation or suspension, the authorized officer also shall give the
holder a reasonable period, not to exceed 30 days, to complete corrective action prescribed by the
authorized officer.
15. The authorized officer may immediately suspend this permit in whole or in part when necessary to
protect public health or safety or the environment. The suspension decision must be in writing. Within 10
days of the request of the holder, the superior of the authorized officer shall arrange for an on-the-ground
review of the adverse conditions with the holder. Following this review, the superior shall take action
within 5 days to affirm, modify, or cancel the suspension.
16. Any written decisions by the authorized officer relating to administration of this permit, including
annual ratings of probationary and unacceptable and revocation or suspension decisions, are subject to
the administrative appeal regulations at 36 CFR Part 214. Revocation or suspension of this permit shall
not give rise to any claim for damages by the holder against the Forest Service.

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17. This permit shall terminate when by its terms a fixed or agreed upon condition, event, or time occurs
without any action by the authorized officer. Examples include but are not limited to expiration of the
permit by its terms on a specified date and termination upon change of control of the business entity and
issuance of a new permit to another party for the use and occupancy authorized in this permit.
Termination of this permit is not subject to administrative appeal and shall not give rise to any claim for
damages by the holder against the Forest Service.
18. This permit, which is revocable and terminable, is not a contract or a lease, but rather a federal
license. The benefits and requirements conferred by this authorization are reviewable solely under the
procedures set forth in 36 CFR Part 251, Subpart C, and 5 U.S.C. 704. This permit does not constitute a
contract for purposes of the Contract Disputes Act, 41 U.S.C. 601. The permit is not real property, does
not convey any interest in real property, and may not be used as collateral for a loan. The holder may not
assign all or part of the authorized use to others.
19. a. As it relates to the use and occupancy on Shawnee National Forest System lands, the holder and
its employees shall not discriminate against any person on the basis of race, color, sex (in educational
activities), national origin, age, or disability or by curtailing or refusing to furnish accommodations,
facilities, services, or use privileges offered to the public generally. In addition, as applicable, the holder
and its employees shall comply with the provisions of Title VI of the Civil Rights Act of 1964 as amended,
Section 504 of the Rehabilitation Act of 1973, as amended, Title IX of the Education Amendments of
1972, as amended, and the Age Discrimination Act of 1975, as amended.
b. The holder shall include and require compliance with the above nondiscrimination provisions in any
third-party agreement made with respect to the operations authorized under this permit as it relates to the
use and occupancy on Shawnee National Forest System land.

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c. The Forest Service shall furnish signs setting forth this policy of nondiscrimination. These signs shall be
conspicuously displayed on the premises and at other exterior or interior locations, as directed by the
Forest Service.
d. The Forest Service shall have the right to enforce the foregoing nondiscrimination provisions by suit for
specific performance or by any other available remedy under the laws of the United States or the State in
which the violation occurs.
20. In addition to the nondiscrimination policy in clause 19, the holder agrees to insure that its programs
and activities as they relate to the use and occupancy on Shawnee National Forest System land are open
to the general public on an equal basis and without regard to any non-merit factor.

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21. The Forest Service reserves the right to regulate the adequacy, type, and price of services provided
to the public on Shawnee National Forest System lands and to require that these services conform to
satisfactory standards. The holder may be required to furnish a schedule of prices for sales and services
authorized by this permit. Such prices and services may be regulated by the Forest Service, provided that
the holder shall not be required to charge prices significantly different from those charged by comparable
or competing businesses. The
Forest Service shall not have the right to regulate prices for sales and services rendered and supplied on
holder’s lands or offsite of Shawnee National Forest Systems lands.
22. Signs posted on Shawnee National Forest System lands must have prior written approval of the
authorized officer.
23. The holder shall not misrepresent in any way, either orally, in its circulars, brochures, advertising, and
other materials, or on its World Wide Web site, signs, or letterheads, any aspect of the use authorized by
this permit, including services provided by the holder, the status of this permit, or the area it covers. All of
the holder's circulars, brochures, and advertising and its World Wide Web site regarding use of the permit
area may state that the permit area is located in the Shawnee National Forest.

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24. Executive Order 13706, Establishing Paid Sick Leave for Federal Contractors, and its implementing
regulations, including the federal contractor paid sick leave clause at 29 CFR Part 13, Appendix A, are
incorporated by reference into this authorization as if fully set forth in this authorization.

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25. This permit does not provide for the furnishing of road or trail maintenance, water, fire protection,
search and rescue, or any other such service by a government agency, utility, association, or individual.
26. No member of or delegate to Congress or resident commissioner shall benefit from this permit either
directly or indirectly, except to the extent the authorized use provides a general benefit to a corporation.
27. This permit, and any appendices incorporated into this permit by reference, constitute the complete
understanding of the parties to this permit as to the rights, duties, and obligations of each party as of the
date of issuance of this permit. In the event of any inconsistencies between any of the preceding clauses
and any subsequent clauses or any provisions in the appendices attached to this permit, the preceding
clauses shall govern.
28. The Hidden Springs District Ranger, Vienna, Illinois, Telephone No. 618-658-2111, is responsible for
administering this special-use authorization. The holder should contact the District Ranger regarding any
questions concerning the occupancy and use authorized and the provisions of this authorization.

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This permit is accepted subject to all its terms and conditions.
U.S. DEPARTMENT OF AGRICULTURE
Forest Service

By: _________________________________

By: _________________________________

Address:

Phone #

District Ranger,
Hidden Springs Ranger District
602 N. First Street
Vienna, Illinois 62995
(Authorized Officer)
Phone #: 618-658-2111

Date:

Date:

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HOLDER: ____________________________

PAPERWORK REDUCTION ACT STATEMENT

According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to
respond to, an information collection request unless it displays a valid Office of Management and Budget (OMB) control number.
The valid OMB control number for this information collection request is 0596-0082. Response to this information collection request
is required to obtain or retain benefits, specifically, a special use authorization. The authority for this information collection request is
Federal Lands Recreation Enhancement Act, 16 U.S.C. 6801-6814 and R9 Shawnee 2709.11-2006-1. The time required to
complete this information collection request is estimated to average 1 hour per response, including the time for reviewing
instructions, searching existing data sources, collecting and maintaining the data needed, and completing and reviewing the
information collection request. Send comments regarding this burden estimate or any other aspect of this information collection
request, including suggestions for reducing the burden, to Forest Service Information Collections Officer,
SM.FS.InfoCollect@usda.gov, with OMB control number 0596-0082 in the subject line.
PRIVACY ACT STATEMENT

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Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act statement serves to inform you of the following concerning the collection of the
information on this form.
Purpose: The Privacy Act of 1974 requires that the Director of Recreation, Heritage, and Volunteer Resources staff and the
Director of Lands, Minerals, and Geology Management staff provide the following statements to individuals from whom they request
information.

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Authority: Collection of this information solicited on this form is authorized by Federal Lands Recreation Enhancement Act, 16
U.S.C. 6801-6814 and R9 Shawnee 2709.11-2006-1.
Routine Uses: The information collected will be used by Forest Service officials to ensure that your use of National Forest System
lands is administered in accordance with applicable statutes, regulations, and directives. The information collected from you is
retained in the Special Uses Data System (SUDS) and is retrieved by the Forest Service create reports for the Agency’s Special
Uses Program, generate bills for collection of land use fees for your authorization, monitor compliance with your special use
authorization, and other matters pertaining to administration of your special use authorization. SUDS is a component of the Forest
Service’s Natural Resources Manager database (NRM). A complete list of the routine uses of NRM can be found in the system of
records notice associated with this form, FS-24.
Disclosure: The submission of this information is required to obtain or retain benefits, specifically, a special use authorization.
NONDISCRIMINATION STATEMENT
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the
USDA, its agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income
derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or
activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by
program or incident.

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Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA
through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in
languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the
letter all the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit the completed
form or letter to USDA by (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

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USDA is an equal opportunity provider, employer, and lender.

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