Appendix_F_-_Proposed_Lessee's_Cover_Page_-_FINAL.pdf

Request for Qualifications No. AFCEC 17-R-0003

Request for Qualifications No. AFCEC-17-R-0003 Page 1 of 2 F.E. Warren Air Force Base EUL Appendix F

United States Department of the Air Force

Air Force Civil Engineer Center (AFCEC)

Enhanced Use Leasing Project F. E. Warren Air Force Base

Request for Qualifications (RFQ) Appendix F Proposed Lessee’s Cover Page

RFQ No. AFCEC-17-R-0003

PROPOSALS ARE DUE NO LATER THAN 5:00 P.M. CT on __ in accordance with Section 4.3, Submission of Responses

Request for Qualifications No. AFCEC 17-R-0003

Request for Qualifications No. AFCEC-17-R-0003 Page 2 of 2 F.E. Warren Air Force Base EUL Appendix F

APPENDIX F

PROPOSED LESSEE’S COVER PAGE

Request for Qualifications

F. E. Warren AFB Enhanced Use Leasing Project

PROPOSED LESSEE:

(Name of Company) (Point of Contact)

(Street Address) (Telephone Number)

(City, State and Zip Code) (Fax Number)

(Electronic Mail Address)

1. Receipt of amendment(s) is acknowledged.

2. Conflicts of Interest I hereby certify that to the best of my knowledge no potential conflict of interest exists between the above-identified Proposed Lessee and either Jones Lang LaSalle, EMAX Financial & Real Estate Advisory Services, LLC, MC Fuhrman and Associates, LLC or Concourse FPS, LLC or any of its subcontractors. As a condition of this offer, should my firm be the Highest Ranked Offeror, my firm will not contract with Jones Lang LaSalle, EMAX Financial & Real Estate Advisory Services, LLC or MC Fuhrman and Associates, LLC for work relating to this project for a period of two years after the date of this selection, nor at any time with Concourse FPS, LLC or any of its subcontractors for work relating to this project.

Authorized representative and signatory for Proposed Lessee:

(Print) Name Title Date