Exhibit 3,

264 FW 2
Sample Memorandum for Approval of Agreement with a Private Entity

Date: October 9, 2009

Series: Finance

Part 264: Cost Recovery and Reimbursable Agreements

Originating Office: Division of Financial Management



PDF Version


Microsoft Word Version



To:                   Director -or- Regional Director



Through: Assistant Director - Business Management and Operations -or- (if the Regional Director is the approval authority, provide a copy of the memorandum to the assistant Director Business Management and Operations)


From:               Assistant Director/Regional Director/Assistant Regional Director


Subject:            Request for Reimbursable Authority with [name of private entity]


In accordance with Service Manual Part 264, chapter 2, I request your approval to enter into an agreement with [name of private entity] for reimbursable work.


Consistency with the Service's National Mission


The [name of private entity] requested that the Service's [Region/field office] perform the following work:


Summary of services or product that we will provide and estimated reimbursement


We estimate that completion of this work will help to [benefits to be achieved], consistent with the Service's mission.


Why is _______________ requesting the Service's expertise?


Summary of scope of work and cost of agreement.


After both parties accept this agreement, [name of private entity] agrees to make an advance payment to the U.S. Fish and Wildlife Service for $______.




 _____    Approved                                                                                Date:___________

_____    Not Approved               Director, U.S. Fish and Wildlife Service         

-or- Regional Director [see sections 2.5, 2.12, and 2.18 for

conditions of Regional approval]





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