9 - Exhibit H - 2025 04 VA GSAR Representation 552 270 33 Nov 24.pdf

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X1DB--FY27 New: Primary Care Clinic Vero Beach New Lease
Solicitation number
36C24826R0042
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GSAR 552.270-33 Foreign Ownership and Financing Representation for High-Security Leased Space

This is a federal contracting form template (GSAR clause 552.270-33) for representing foreign ownership and financing interests related to high-security leased space. The form applies to RLP # 36C248-26-R-0042 and is effective as of November 2024. Offerors must complete and sign this representation when submitting a proposal for a lease opportunity involving high-security space. The document defines key terms including "foreign entity," "foreign person," "immediate owner," "highest-level owner," and "financing" to establish the scope of disclosure requirements.

The representation requires offerors to disclose whether they have an immediate owner, and if so, whether that owner is a foreign entity or foreign person. Offerors must also identify any highest-level owner above an immediate owner and its foreign status. Additionally, offerors must disclose whether financing for the lease involves any foreign entity or foreign person. For each affirmative response regarding foreign involvement, offerors must provide the entity's legal name, unique entity identifier (if available), physical address, and country. If the offeror becomes the successful awardee (lessor), the form must be reviewed, updated, and resubmitted annually starting one year from the Lease Term Effective Date through final contract payment, reflecting all changes to ownership and financing. The lessor remains responsible for the accuracy, completeness, and currency of all disclosed information.

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2 - Exhibit A - 36C248-26-L-0007 - Global Lease Template L100 -May 2026.pdf PDF
3 - Exhibit B - Agency Special Requirements ASR Revised Jan 26.pdf PDF
4 - Exhibit C - Security Requirements FSL Level II Oct 24.pdf PDF
12 - Exhibit K - Tenant Improvements Cost Summary TICS Table Oct 24.xlsx XLSX spreadsheet
1 - 36C248-26-R-0042 - Global Request for Lease Proposal -RLP- Template R100 -May 2026.pdf PDF
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RLP 36C248-26-R-0042 Updated Sections.pdf PDF
11 - Exhibit J - Sample Request for Past Performance and Questionaire.pdf PDF
13 - Exhibit L - Security Unit Price List FSL II Oct 2024.xlsx XLSX spreadsheet
1 - 36C248-26-R-0042 - Global Request for Lease Proposal RLP Template R100 June 2025.pdf PDF
7 - Exhibit F - 3516 Solicitation Provisions Feb 2025.pdf PDF
5 - Exhibit D - Form 1364 Proposal to Lease Space Jan 2023.pdf PDF
6 - Exhibit E - GSA Form 1217 Lessor Annual Cost.pdf PDF
2 - Exhibit A - 36C248-26-L-0007 - Global Lease Template L100 Sep 2025.pdf PDF
8 - Exhibit G - 3517B General Clauses Feb 2025.pdf PDF
12 - Exhibit K - Tenant Improvements Cost Summary TICS Table Oct 2024.xlsx XLSX spreadsheet
10 - Exhibit I - GSA Form 12000 Prelease FPLS Evaluation Part A Part B May 2015.pdf PDF
15 - Exhibit N - Deliverables IAW RLP 36C248-26-R-0042.xlsx XLSX spreadsheet
14 - Exhibit M - Labor Standards Provisions and DOL Wage Determination.pdf PDF
36C248-26-R-0042_3.docx DOCX document
3 - Exhibit B - Agency Special Requirements Vero Beach PC.pdf PDF
9 - Exhibit H - 2025 04 VA GSAR Representation 552 270 33 Nov 2024.pdf PDF
4 - Exhibit C - Security Requirements FSL Level II Oct 2024.pdf PDF
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LESSOR:_____ GOVERNMENT:_____ GSAR 552.270-33 Foreign Ownership and Financing Representation for High-Security Leased Space JUN 2021 – Updated Template 11/12/2024

RLP # 36C248-26-R-0042 – EXHIBIT H

2025 04 VA GSAR Representation 552 270 33 Nov 2024

Offerors’ Initial Representation: Complete the representation below, sign and return to the Lease Contracting Officer (LCO) or his/her designee. NOTE: The "Offeror," as used on this form, is the owner of the property offered, not an individual or agent representing the owner.

552.270-33 Foreign Ownership and Financing Representation for High-Security Leased Space.

FOREIGN OWNERSHIP AND FINANCING REPRESENTATION FOR HIGH-

SECURITY LEASED SPACE (JUN 2021)

(a) Definitions. As used in this clause–

Financing means the process of raising or providing funds through debt or equity for purposes of meeting the requirements of the Lease, including, but not limited to, acquisition, maintenance, and construction of, or improvements to, the Property.

Foreign entity means a:

(i) Corporation, company, business association, partnership, society, trust, or any other nongovernmental entity, organization, or group that is headquartered or organized under the laws of a country that is not the United States or a state, local government, tribe, or territory within the United States; or

(ii) Government or governmental instrumentality that is not the United States Government.

Foreign person means an individual who is not:

(i) A United States citizen; or

(ii) An alien lawfully admitted for permanent residence in the United States.

Highest-level owner means the entity that owns or controls an immediate owner of the offeror or Lessor, or that owns or controls one or more entities that control an immediate owner of the offeror or Lessor. No entity owns or exercises control of the highest-level owner.

Immediate owner means an entity, other than the offeror or Lessor, that has direct control of the offeror or Lessor. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

Leased Space JUN 2021 – Updated

Unique entity identifier means a number or other identifier used to identify a specific commercial, nonprofit, or Government entity. See www.sam.gov for the designated entity for establishing unique entity identifiers.

(b) Timing. The Offeror or Lessor shall complete this representation when submitting a proposal. If the Offeror is the successful awardee, the Offeror (now Lessor) shall review, update, and provide this representation on an annual basis, reflecting all changes to immediate owner, highest-level owner and financing during the preceding 1-year period, starting one year from the Lease Term Effective Date through final payment of any contract. If the Lessor intends to transfer the lease to a successor in interest under the circumstances set forth in FAR 42.1204, the Lessor shall submit this representation to the Lease Contracting Officer with any request to novate the lease. The Offeror or Lessor is responsible for the currency, accuracy and completeness of the data disclosed, and for any liability resulting from the Government's reliance on inaccurate or incomplete data.

(c) Immediate owner.

(1) The Offeror or Lessor represents that it □ does or □ does not have an immediate owner.

(2) If the Offeror or Lessor indicates "does" in paragraph (c)(1) of this clause, then enter the following information for the immediate owner. If the offeror or Lessor has more than one immediate owner (e.g., joint venture), then the offeror or Lessor shall provide the information for each entity.

Legal name (do not use a “doing business as” name)

Unique entity identifier (if available)

(3) If the Offeror or Lessor indicates "does" in paragraph (c)(1) of this clause, then complete this additional representation: Is the immediate owner a foreign entity?:

□ Yes or □ No.

(4) If the Offeror or Lessor indicates "does" in paragraph (c)(1) of this clause, then complete this additional representation: Is the immediate owner a foreign person?:

□ Yes or □ No.

(5) If the Offeror or Lessor indicates "Yes" in either paragraph (c)(3) or (4) of this clause, indicating that there is foreign ownership (as a foreign entity or foreign person), then enter the following information for the foreign owner (respond for each as applicable).

Physical address

Country

Leased Space JUN 2021 – Updated

(d) Highest-level owner.

(1) The Offeror or Lessor represents that the immediate owner, if any, □ is or □ is not owned or controlled by another entity?

(2) If the Offeror or Lessor indicates "is" in paragraph (d)(1) of this clause, indicating that the immediate owner is owned or controlled by another entity, then enter the following information for the highest-level owner.

(3) If the Offeror or Lessor indicates "is" in paragraph (d)(1) of this clause, then complete this additional representation: Is the highest-level owner a foreign entity?:

□ Yes or □ No.

(4) If the Offeror or Lessor indicates "is" in paragraph (d)(1) of this clause, then complete this additional representation: Is the highest-level owner a foreign person?:

□ Yes or □ No.

(5) If the Offeror or Lessor indicates "Yes" in either paragraph (d)(3) or (4) of this clause, indicating that there is foreign ownership (as a foreign entity or foreign person), then enter the following information for the foreign owner (respond for each as applicable).

(e) Financing entity.

(1) The Offeror or Lessor represents that the financing □ does or □ does not involve a foreign entity?

(2) The Offeror or Lessor represents that the financing □ does or □ does not involve a foreign person?

(3) If the Offeror or Lessor indicates "does" in either paragraph (e)(1) or (2) of this clause, indicating foreign financing (as a foreign entity or foreign person), then enter the following information for the foreign financing (respond for each as applicable).

Leased Space JUN 2021 – Updated

(End of clause)

OFFEROR OR

LESSOR NAME

AND SIGNATURE

Name

Signature

Date

File details come from the government source that posted it. Updated .