B.SF-81.pdf

REQUEST FOR SPACE

(See instructions on reverse)

1. DATE

GENERAL SERVICES ADMINISTRATION

PUBLIC BUILDINGS SERVICE

2. AGENCY REQUEST NO. 3. LOCAL AGENCY CONTACT (Name) PHONE NO. PHONE NO.4. AGENCY MARKET SURVEY REPRESENTATIVE (Name)

7. FOR:

ZIP CODE

CITY & STATE

NO., STREET

AGENCY

6. FROM:

ZIP CODE

CITY & STATE

NO., STREET

5. TO:

8. TYPE OF REQUEST

FROM (mo. & yr.) TO (mo. & yr.)

9a. GEOGRAPHIC SERVICE AREA

11. TOTAL NO. OF PERSONNEL TO BE HOUSED

13. SPECIAL REQUIREMENTS AND SERVICES (see attached)

SIGNATURE

SIGNATURE OF AUTHORIZED GSA OFFICIAL

SPACE REQUEST NO.

NAME OF GSA REGIONAL CONTACT

DATE RECEIVED

PHONE NO.

STANDARD FORM 81 (REV. 2-89)

Prescribed by GSA-FPMR (41 CFR) 101-17

PRINT NAME AND TITLE

PHONE NO. DATE

PRINT NAME AND TITLE

ATTACHMENT(S)

9b. DELINEATED AREA

NO. OF YEARS FIRM TERM

INITIAL

EXPANSION

10. TERM OF OCCUPANCY

CONTINUING REQUIREMENTS

REDUCTION

AGENCY

ADDRESS

ZIP CODE

BUREAU CODE

12. SPACE REQUIREMENTS

TYPE OF SPACE

PRIMARY OFFICE

AREA

NO. OF

PERSONNEL

SQ. FT.

PER PERSON SQ. FT. TOTALS

OFFICE SUPPORT

AREA

OFFICE SPACE

SUBTOTAL

ST 1 GENERAL STORAGE

WAREHOUSE STORAGEST 2

SP 1

SP 2

SP 3

SP 4

SP 5

SP 6

SP 7

ST 2 INSIDE PARKING (No. of spaces)

LABORATORY & CLINIC

FOOD SERVICE AREA

STRUCTURALLY CHANGED

AUTOMATED DATA PROCESSING

CONFERENCE & TRAINING

LIGHT INDUSTRIAL

QUARTERS/RESIDENTIAL HOUSING

OUTSIDE PARKING (No. of spaces)

TOTAL PARKING SPACES (Lines o, p)

GENERAL SERVICES ADMINISTRATION

SPECIAL SUBTOTAL (Lines e-k)

TOTAL SPACE REQUIRED (Lines a, d, & l)

OPEN LAND (Total acres)

STORAGE SUBTOTAL (Lines b, c) a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

k.

l.

m.

n.

o.

p.

q.

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G E

S P

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14. AGENCY CERTIFICATION

15. FOR GSA USE ONLY

(Action by Authorized GSA Official)

GOV'T CONTROLLED SPACE TO BE ASSIGNED

NO GOV'T SPACE AVAILABLE LEASING ACTION PLANNED

UNIQUE AGENCY SPACE DETERMINED - SEE ATTACHED

AGENCY AUTHORIZED TO ACQUIRE SPACE UNDER ITS OWN AUTHORITY

COMMENTS ATTACHED

I certify that this request is accurate and complete; is for the minimum amount of space required; is in compliance with FPMR 101-17, including all laws and executive orders governing the location of space; and that funds are available for payment of rent, moving expenses, telecommunication expenses, and any related reimbursable costs.©

INSTRUCTIONS

Submitting the SF-81 Submit the SF-81 in triplicate, accompanied by a completed SF-81A, Space Requirements Worksheet, Space Requirements Questionnaire and any additional documentation to fully support the agency's space needs. Failure to provide complete and accurate information will delay processing and may result in return of the SF-81 for correction, update and resubmission.

The SF-81 must be submitted by the office which has authority to obligate funds to reimburse GSA for all applicable costs associated with the delivery of space.

Agency field components which do not have delegated authority to obligate funds must coordinate submission and approval of the SF-81 with offices which have this authority. A GSA Form 2957, Reimbursable Work Authorization, should be submitted when applicable.

Item 1. Date form is prepared.

Item 2. Agency established request number Item 3. Name and phone number of the local agency official who is knowledgable of the request and will serve as the agency's point of contact for this project.

Item 4. Name and phone number of agency representative who will work with GSA if a market survey is conducted. This individual must have the authority to determine acceptability of the building and/or sites and their location.

Item 5. GSA regional office which has jurisdiction for geographical area where space is required.

Item 6. Name and address of organization making the request.

Item 7. Name of agency, and bureau code of the organization which will occupy the space (e.g., regional office, district office, field office) if different than information provided in block 6. City and state where the space is requested.

Item 8. Type of request. Initial: A request for new space that is not associated with an existing assignment. Expansion: A request for additional space associated with an existing assignment. Continuing requirements: A space action required for a lease renewal, succeeding lease, lease extension or move.

Reduction: A space action that requires regional Real Estate Division effort to effect the partial or total termination of an assignment.

Item 9a. and 9b. Geographic/Delineated area that the agency will service. The geographic area (State, city, county, zip code, etc.) for which an agency/bureau has operational responsibility as well as the specific delineated area as identified and justified by the requesting agency. GSA review of the delineated area shall be limited to ensuring that the delineated area will provide adequate competition and the maximum use of existing Government controlled space (see Item 14 Agency Certification).

Item 10. Period of time the organization will use the space and the suggested number of years for a firm term period. This time period must be representative of the longest period for which the agency can commit. "Indefinite" and "ASAP" are not acceptable responses.

Item 11. Total number of personnel to occupy the requested space. ("Personnel" means the peak number of persons to be housed, regardless of how many workstations are provided for them. In addition to permanent employees of the agency, personnel includes temporaries, part-time, seasonal, contractual employees and budgeted vacancies.)

Item 12, line a. This line identifies the Office Space Subtotal. The Office Space Subtotal is determined by entering the amount of space required for the primary office area and adding this to the amount required for the office support area. "Primary Office Area" is the primary people occupied area in which an activity's normal operational functions are performed.

Item 12, lines b, c. Amount of general and warehouse storage space is required. (See items 12, line o for ST 2 inside parking).

Item 12, line d. Total amount of storage space required (Add lines b and c).

Item 12, lines e-k. Amount of special space required.

Item 12, line l. Total amount of special space required (Add lines e through k).

Item 12, line m. Total amount of Office, Storage and Special space required. (Add lines a, d, and l).

Item 12, line n. Total acres needed. For amounts less than 1 acre, 1 acre equals 43,560 square feet.

Item 12, line o, p. Agency's inside and outside parking requirement. Certification that the parking is necessary for the efficient operation of the agency mission is required. One parking space equals 300 square feet. Please indicate the number of spaces.

Item 12, line q. Total parking spaces required. (Add lines o and p).

Item 13. This item refers to the specific architectural, mechanical, electrical, structural, and other special requirements related to each of the types of space requested in Item 12. These include security; electrical; HVAC; floor loading; sound conditioning; fire and safety; and the need for after hours building access, utilities, and cleaning services. Such requirements must be fully defined by area, including computer rooms, laboratories, conference rooms, etc.

These requirements must be specified in detail on the Space Requirements Questionnaire and SF-81A. Check box in Item 13 to indicate if this information is attached.

Agency Certification Item 14. The certification must be signed by an authorized agency official.

Item 15. GSA will evaluate the request in terms of the space available in its inventory and determine the appropriate action. If GSA determines that space requested is unique agency space, GSA will take no action until the agency has concurred with that designation. GSA will assign a space request number which will be used to track the request until it is satisfied.

Name and phone number of the GSA regional official who is knowledgable of the request and will serve as GSA's point of contact.

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REQUEST FOR SPACE

(See instructions on reverse)

1. DATE

GENERAL SERVICES ADMINISTRATION

PUBLIC BUILDINGS SERVICE

2. AGENCY REQUEST NO.

3. LOCAL AGENCY CONTACT (Name)

PHONE NO.

PHONE NO.

4. AGENCY MARKET SURVEYREPRESENTATIVE (Name)

7. FOR:

ZIP CODE

CITY & STATE

NO., STREET

AGENCY

6. FROM:

ZIP CODE

CITY & STATE

NO., STREET

5. TO:

8. TYPE OF REQUEST

FROM (mo. & yr.)

TO (mo. & yr.)

9a. GEOGRAPHIC SERVICE AREA

11. TOTAL NO. OF PERSONNEL TO BE HOUSED

13. SPECIAL REQUIREMENTS AND SERVICES (see attached)

SIGNATURE

SIGNATURE OF AUTHORIZED GSA OFFICIAL

SPACE REQUEST NO.

NAME OF GSA REGIONAL CONTACT

DATE RECEIVED

PHONE NO.

STANDARD FORM 81 (REV. 2-89)

Prescribed by GSA-FPMR (41 CFR) 101-17

PRINT NAME AND TITLE

PHONE NO.

DATE

PRINT NAME AND TITLE

ATTACHMENT(S)

9b. DELINEATED AREA

NO. OF YEARS FIRM TERM

INITIAL

EXPANSION

10. TERM OF OCCUPANCY

CONTINUING REQUIREMENTS

REDUCTION

AGENCY

ADDRESS

ZIP CODE

BUREAU CODE

12. SPACE REQUIREMENTS

TYPE OF SPACE

PRIMARY OFFICE

AREA

NO. OF

PERSONNEL

SQ. FT.

PER PERSON

SQ. FT.

TOTALS

OFFICE SUPPORT

AREA

OFFICE SPACE

SUBTOTAL

ST 1

GENERAL STORAGE

WAREHOUSE STORAGE

ST 2

SP 1

SP 2

SP 3

SP 4

SP 5

SP 6

SP 7

ST 2

INSIDE PARKING (No. of spaces)

LABORATORY & CLINIC

FOOD SERVICE AREA

STRUCTURALLY CHANGED

AUTOMATED DATA PROCESSING

CONFERENCE & TRAINING

LIGHT INDUSTRIAL

QUARTERS/RESIDENTIAL HOUSING

OUTSIDE PARKING (No. of spaces) TOTAL PARKING SPACES (Lines o, p)

GENERAL SERVICES ADMINISTRATION

SPECIAL SUBTOTAL (Lines e-k) TOTAL SPACE REQUIRED (Lines a, d, & l) OPEN LAND (Total acres) STORAGE SUBTOTAL (Lines b, c) a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

k.

l.

m.

n.

o.

p.

q.

OFFICE

STORAGE

SPECIAL

14. AGENCY CERTIFICATION

15. FOR GSA USE ONLY

(Action by Authorized GSA Official)

GOV'T CONTROLLED SPACE TO BE ASSIGNED

NO GOV'T SPACE AVAILABLE LEASING ACTION PLANNED

UNIQUE AGENCY SPACE DETERMINED - SEE ATTACHED

AGENCY AUTHORIZED TO ACQUIRE SPACE UNDER ITS OWN AUTHORITY

COMMENTS ATTACHED

I certify that this request is accurate and complete; is for the minimum amount of space required; is in compliance with FPMR 101-17, including all laws and executive orders governing the location of space; and that funds are available for payment of rent, moving expenses, telecommunication expenses, and any related reimbursable costs.

INSTRUCTIONS

Submitting the SF-81 Submit the SF-81 in triplicate, accompanied by a completed SF-81A, Space Requirements Worksheet, Space Requirements Questionnaire and any additional documentation to fully support the agency's space needs. Failure to provide complete and accurate information will delay processing and may result in return of the SF-81 for correction, update and resubmission.

The SF-81 must be submitted by the office which has authority to obligate funds to reimburse GSA for all applicable costs associated with the delivery of space. Agency field components which do not have delegated authority to obligate funds must coordinate submission and approval of the SF-81 with offices which have this authority. A GSA Form 2957, Reimbursable Work Authorization, should be submitted when applicable.

Item 1. Date form is prepared.

Item 2. Agency established request number Item 3. Name and phone number of the local agency official who is knowledgable of the request and will serve as the agency's point of contact for this project.

Item 4. Name and phone number of agency representative who will work with GSA if a market survey is conducted. This individual must have the authority to determine acceptability of the building and/or sites and their location.

Item 5. GSA regional office which has jurisdiction for geographical area where space is required.

Item 6. Name and address of organization making the request.

Item 7. Name of agency, and bureau code of the organization which will occupy the space (e.g., regional office, district office, field office) if different than information provided in block 6. City and state where the space is requested.

Item 8. Type of request. Initial: A request for new space that is not associated with an existing assignment. Expansion: A request for additional space associated with an existing assignment. Continuing requirements: A space action required for a lease renewal, succeeding lease, lease extension or move. Reduction: A space action that requires regional Real Estate Division effort to effect the partial or total termination of an assignment.

Item 9a. and 9b. Geographic/Delineated area that the agency will service. The geographic area (State, city, county, zip code, etc.) for which an agency/bureau has operational responsibility as well as the specific delineated area as identified and justified by the requesting agency. GSA review of the delineated area shall be limited to ensuring that the delineated area will provide adequate competition and the maximum use of existing Government controlled space (see Item 14 Agency Certification).

Item 10. Period of time the organization will use the space and the suggested number of years for a firm term period. This time period must be representative of the longest period for which the agency can commit. "Indefinite" and "ASAP" are not acceptable responses.

Item 11. Total number of personnel to occupy the requested space. ("Personnel" means the peak number of persons to be housed, regardless of how many workstations are provided for them. In addition to permanent employees of the agency, personnel includes temporaries, part-time, seasonal, contractual employees and budgeted vacancies.)

Item 12, line a. This line identifies the Office Space Subtotal. The Office Space Subtotal is determined by entering the amount of space required for the primary office area and adding this to the amount required for the office support area. "Primary Office Area" is the primary people occupied area in which an activity's normal operational functions are performed.

Item 12, lines b, c. Amount of general and warehouse storage space is required. (See items 12, line o for ST 2 inside parking).

Item 12, line d. Total amount of storage space required (Add lines b and c).

Item 12, lines e-k. Amount of special space required.

Item 12, line l. Total amount of special space required (Add lines e through k).

Item 12, line m. Total amount of Office, Storage and Special space required. (Add lines a, d, and l).

Item 12, line n. Total acres needed. For amounts less than 1 acre, 1 acre equals 43,560 square feet.

Item 12, line o, p. Agency's inside and outside parking requirement. Certification that the parking is necessary for the efficient operation of the agency mission is required. One parking space equals 300 square feet. Please indicate the number of spaces.

Item 12, line q. Total parking spaces required. (Add lines o and p).

Item 13. This item refers to the specific architectural, mechanical, electrical, structural, and other special requirements related to each of the types of space requested in Item 12. These include security; electrical; HVAC; floor loading; sound conditioning; fire and safety; and the need for after hours building access, utilities, and cleaning services. Such requirements must be fully defined by area, including computer rooms, laboratories, conference rooms, etc. These requirements must be specified in detail on the Space Requirements Questionnaire and SF-81A. Check box in Item 13 to indicate if this information is attached.

Agency Certification Item 14. The certification must be signed by an authorized agency official.

Item 15. GSA will evaluate the request in terms of the space available in its inventory and determine the appropriate action. If GSA determines that space requested is unique agency space, GSA will take no action until the agency has concurred with that designation. GSA will assign a space request number which will be used to track the request until it is satisfied.

Name and phone number of the GSA regional official who is knowledgable of the request and will serve as GSA's point of contact.

8.2.0.3062.1.452232.445150