ATTACHMENT 3 LOW-Rise Form 12000.pdf

PRELEASE

FIRE PROTECTION AND LIFE SAFETY

EVALUATION FOR A LOW-RISE OFFICE BUILDING

ATTACHMENT # 3

GENERAL SERVICES ADMINISTRATION PAGE 1 of 5 GSA FORM 12000 (5/2005)

The Offeror or the Offeror’s representative shall complete this form based on a walk-through of the building or their knowledge of the building’s fire protection and life safety systems. This form consists of a series of short answer and yes/no/not applicable questions related to the building’s fire protection and life safety systems.

1. Fundamental Code Requirements.

a. The offered building shall be evaluated for compliance with the most recent edition of the building and fire code adopted by the jurisdiction in which the building is located; with the exception that the technical egress requirements of the building shall be evaluated based on the egress requirements of the National Fire Protection Association (NFPA) 101, Life Safety Code. All areas that do not meet the above stated criteria shall be identified as to the extent that they do comply.

2. Definitions.

a. Low-Rise Building: A building less than 75 feet in height where the building height is measured from the lowest level of fire department vehicle access to the floor of the highest occupied floor. A building that is 5 stories or less in height is typically considered a low-rise building.

b. Hazardous Areas: Any space or compartment within a building in which storage or other activity exists that is not part of normal office space arrangements and that possesses the potential for producing a fully involved fire. Such areas used for: the storage or use of combustibles or flammables; toxic, noxious, or corrosive materials; or heat producing appliances, etc. (as defined in the latest edition of NFPA 101, Life Safety Code).

The Offeror states, as part of this offer, that the proposed space/building is as described below and that the information provided is accurate. In addition, the Offeror agrees all features and devices described below are in operating order and properly maintained. THIS SFO PRELEASE FORM WILL BE COMPLETED BY THE OFFEROR OR THE OFFEROR'S REPRESENTATIVE. Please provide additional pages should this form not provide sufficient space to respond adequately to any question.

BUILDING ADDRESS

Building Name:

Building Address:

City:

State:

9-Digit Zip Code:

BUILDING CODE AND FIRE CODE ADOPTED BY LOCAL JURISDICTION

Building Code: YEAR:

Fire Code: YEAR:

SIZE AND LAYOUT

The following information applies to (check one): an existing building a building planned for lease construction a building planned for lease construction with Government option to purchase

Identify each floor in which space is offered to Government:

Identify gross square footage of space offered to Government on each floor:

Identify height (in feet) of the building above the lowest level of fire department vehicle access:

Identify the number of floors above the lowest level of fire department vehicle access:

Identify the number of floors below the lowest level of fire department vehicle access:

OTHER OCCUPANCIES IN BUILDING (Check All That Apply) Restaurants Laboratories Storage Retail Other (list)

GENERAL SERVICES ADMINISTRATION PAGE 2 of 5 GSA FORM 12000 (5/2005)

BUILDING CONSTRUCTION TYPE (Check One) Fire resistive Heavy Timber Ordinary Wood Frame Unprotective non-combustible

VERTICAL OPENINGS (CHECK ONE)

Between Two or More Floors

Exit Stairways open enclosed with doors, provide description Shafts open enclosed, provide description Atrium open enclosed, provide description Other open enclosed, provide description None

ELECTRICAL SYSTEM

Please Check YES, NO, or NA to the following question: YES NO NA The building electrical system appears to comply with the NFPA 70, National Electrical Code in that there are no obvious deficiencies (e.g., temporary wiring, use of extension cords, deteriorated equipment, missing equipment, etc.). If potential problems are noted, describe on an attached sheet.

BUILDING EGRESS AND EXITING SYSTEM

Please Check YES, NO, or NA to the following questions: YES NO NA Unrestrictive access is provided to a minimum of two exits on each floor.

Scissor stairs count as only one approved exit.

Fire escapes are not counted as an approved exit.

Corridors have a 1-hour fire-resistive rating.

Exit access is at least 44 inches wide.

All exit stairways terminate directly at a public way or at an exterior exit discharge.

All exit doors swing in the direction of exit travel.

BUILDINGS PROTECTED THROUGHOUT BY AUTOMATIC FIRE SPRINKLERS

Please Check YES, NO, or NA to the following questions: YES NO NA The minimum separation distance between two exits or exit access doors measured in a straight line between the exits or exit access doors shall not be less than one-third the length of the maximum overall diagonal dimension of the building or area served.

The travel distance to the exits is not more than 300 feet.

The maximum length of a dead-end corridor is 50 feet.

The common path of travel is not more than 100 feet in length.

BUILDINGS NOT PROTECTED THROUGHOUT BY AUTOMATIC FIRE SPRINKLERS

Please Check YES, NO, or NA to the following questions: YES NO NA The minimum separation distance between two exits or exit-access doors measured in a straight line between the exits or exit-access doors shall not be less than one-half the length of the maximum overall diagonal dimension of the building or area served.

The travel distance to the exits is not more than 200 feet.

The maximum length of a dead-end corridor is 50 feet.

The common path of travel is not more than 75 feet in length.

GENERAL SERVICES ADMINISTRATION PAGE 3 of 5 GSA FORM 12000 (5/2005)

STANDPIPES AND PORTABLE FIRE EXTINGUISHERS

Please Check YES, NO, or NA to the following questions: YES NO NA Standpipes are installed in building.

Portable fire extinguishers are installed in building.

BUILDING EXIT HARDWARE AND EGRESS DOORS

Please Check YES, NO, or NA to the following questions: YES NO NA All exit stairway doors are in proper working order.

All exit stairway doors are self-closing or automatic-closing; and self-latching.

In an emergency, all exit stairway doors permit re-entry from the exit stairway enclosure to the interior of the building.

Exit doors require one action to open (e.g., no locks, locked during unoccupied periods only).

NOTE: Special locking arrangements may be permitted if allowed by local jurisdiction.

AUTOMATIC FIRE SPRINKLERS

Please Check YES, NO, or NA to the following questions: YES NO NA Automatic fire sprinklers are installed throughout the building.

Automatic fire sprinklers are installed in all below-grade space.

Automatic fire sprinklers are installed only in corridors.

Automatic fire sprinklers are installed in all hazardous areas (as defined by NFPA 101, Life Safety Code).

Automatic fire sprinklers are installed in other locations in the building (describe locations on additional sheet).

Central Sprinkler Company’s Omega line of fire sprinklers are installed in the building (describe location(s), model(s), number of sprinklers, date installed, etc. on additional sheet).

Automatic fire sprinklers having an “O-Ring” are installed in the building (describe location(s), model(s), number of sprinklers, date installed, etc. on additional sheet).

The automatic fire sprinkler system is electronically supervised in accordance with NFPA 13, Standard for Installation of Sprinkler Systems.

The automatic fire sprinkler system is maintained in accordance with the applicable local codes or NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

SMOKE DETECTORS

Please Check YES, NO, or NA to the following questions: YES NO NA Smoke detectors are installed throughout the building.

Smoke detectors are installed only in corridors.

Smoke detectors are installed only in elevator lobbies.

Smoke detectors are installed in all hazardous areas (as defined by NFPA 101, Life Safety Code).

Smoke detectors are installed in other locations in the building (describe other locations on additional sheet).

Duct smoke detectors are installed in the building.

HEAT DETECTORS

Please Check YES, NO, or NA to the following questions: YES NO NA Heat detectors are installed throughout the building.

Heat detectors are installed only in corridors.

Heat detectors are installed in all hazardous areas (as defined by NFPA 101, Life Safety Code).

Heat detectors are installed in other locations in the building (describe other locations on additional sheet).

GENERAL SERVICES ADMINISTRATION PAGE 4 of 5 GSA FORM 12000 (5/2005)

FIRE ALARM SYSTEM

Please Check YES, NO, or NA to the following questions: YES NO NA A fire alarm system is installed in the building.

Audible alarm notification appliances are installed and located throughout the building to be effectively heard above normal conditions of occupancy.

Visible alarm notification appliances are installed and located throughout the building.

Operation of the fire alarm system automatically notifies building occupants to evacuate or relocate within the building.

Operation of the fire alarm system automatically notifies the local fire department or UL central station service.

Emergency power is provided for the fire alarm system.

The fire alarm system has emergency voice communication capabilities.

The fire alarm system is maintained in accordance with the applicable local codes or NFPA 72, National Fire Alarm Code.

HAZARDOUS AREAS

Hazardous Areas as defined by NFPA 101, Life Safety Code

Please Check YES, NO, or NA to the following questions: YES NO NA Hazardous areas are located in the building.

List locations of all hazardous areas in the building (describe locations on additional sheet).

EXIT SIGNS, EMERGENCY LIGHTING, & EMERGENCY POWER

Please Check YES, NO, or NA to the following questions: YES NO NA Illuminated exit signs are installed along exit paths.

Emergency lighting is installed along exit paths.

Emergency power is provided for building’s life safety systems (e.g., exit signs, emergency lighting, fire alarm, etc.).

An emergency generator is installed in the building to provide emergency power to the building’s life safety systems.

An UPS system is installed in the building to provide emergency power to the building’s life safety systems.

INTERIOR FINISH

Please Check YES, NO, or NA to the following questions: YES NO NA Offered space has corkboard installed on walls.

Offered space has carpet installed on walls.

Offered space has wood paneling installed on walls.

ELEVATORS

Please Check YES, NO, or NA to the following questions: YES NO NA Elevators have a current certificate of elevator inspection from the local jurisdiction.

Elevators are equipped with telephones or other two-way emergency signaling systems connected to an emergency communication location manned during normal working hours when the elevators are in service.

Elevators are automatically recalled by smoke detectors located in elevator lobbies and machine rooms.

Elevators recall to an alternate level when activated by primary level smoke detector.

Elevators are equipped with firemen's manual capture feature.

PUBLIC ADDRESS SYSTEMS

Please Check YES, NO, or NA to the following question: YES NO NA

GENERAL SERVICES ADMINISTRATION PAGE 5 of 5 GSA FORM 12000 (5/2005)

An independent public address system is provided throughout the building.