Exhibit_H_GSAR_Representation_552.270-33.pdf

PDF 200 KB Posted

Attached to
Lease of Office Space within Region 3 Federal contract opportunity
Solicitation number
3VA0900
Issued by
General Services Administration Public Buildings Service Region 3

About this file

This is a Foreign Ownership and Financing Representation form (GSAR 552.270-33) for high-security leased space, required as part of a lease proposal for office space in Charlottesville, VA. The form must be completed by property owners/lessors to disclose any foreign ownership, control, or financing arrangements.

The form requires detailed disclosure of immediate owners, highest-level owners, and financing entities, including whether they are foreign entities or persons. Offerors must provide legal names, unique entity identifiers, physical addresses, and countries for any foreign ownership. The representation must be completed initially with proposals and updated annually by lessors throughout the lease term. This template is dated June 2021 and includes checkboxes and fields for entities to declare foreign ownership status and provide required ownership details. The form is part of GSA's enhanced security measures for high-security leased facilities.

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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.

Lessors’ Representation: Complete the annual representation below, sign and return to the Administrative Lease Contracting Officer (ALCO) or his/her designee via GSA’s Leasing Portal at leasing.gsa.gov, or subsequent portal.

Novation Transferees’ Representation: Complete the representation below, sign and return to the ALCO or his/her designee along with other required novation documentation.

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.

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

LESSOR:_____ GOVERNMENT:_____ GSAR 552.270-33 Foreign Ownership and Financing Representation for High-Security

Leased Space JUN 2021 – Updated Template 11/12/2024 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: ______________________________________________________________________________

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.

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

Unique entity identifier: __________________________________________________________________ (if available)

(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.

LESSOR:_____ GOVERNMENT:_____ GSAR 552.270-33 Foreign Ownership and Financing Representation for High-Security

Leased Space JUN 2021 – Updated Template

(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).

Physical Address: ______________________________________________________________________

Country: ______________________________________________________________________________

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).

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

Unique entity identifier: __________________________________________________________________ (if available)

Physical Address: ______________________________________________________________________

Country: ______________________________________________________________________________

(End of clause)

Offeror/Lessor:

Sign and date: _________________________________________________________________________

Name and title: _________________________________________________________________________

LESSOR:_____ GOVERNMENT:_____ GSAR 552.270-33 Foreign Ownership and Financing Representation for High-Security

Leased Space JUN 2021 – Updated Template

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