Exhibit J Seismic Safety Forms.pdf

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Madisonville, KY VA clinic New/replacing Lease_Amendment 2
Solicitation number
36C25525R0036
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About this file

This document is an appendix from the GSA PBS (Public Buildings Service) Leasing Desk Guide, specifically Appendix G focused on Seismic Safety in Leasing. The appendix provides a comprehensive set of six seismic offer forms that must be completed by offerors/engineers when leasing buildings in areas with potential seismic risks. The forms cover different scenarios including benchmark buildings, existing buildings, retrofitted buildings, new construction, and potential exemptions from seismic standards.

The six forms (A through F) serve pre-award and post-award purposes, requiring engineers to evaluate and certify a building's seismic compliance using standards like ASCE/SEI 31 and ASCE/SEI 41. Form A is for benchmark buildings, Form B for existing buildings, Form C for retrofit or new construction commitments, Form D for exemption claims, Form E for retrofitted buildings, and Form F for new buildings. Each form requires detailed documentation about the building's characteristics, design codes, construction years, and a professional engineer's certification, with the ultimate goal of ensuring life safety standards are met in federally leased spaces across different seismic risk zones.

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Appendix G: Seismic Safety in Leasing

Attachment 2: Seismic Offer Forms

Instructions to Leasing Specialists:

The following seismic forms are intended to be issued as an attachment to the RLP package. Therefore, unless the transaction is exempted as described under paragraph 3a of this Appendix, the LeO must attach the entire group of six Seismic Forms to the RLP package. The Offeror/Offeror's engineer must fill out the appropriate form(s) among the four pre-award submittals to complete his or her offer. The pre-occupancy submittals are also included as part of the RLP package, to inform Offerors of potential post-award obligations .

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Exhibit J

RLP OFFER ATTACHMENT - SEISMIC OFFER FORMS

Instructions for Offeror:

Forms A through D are pre-award submittals . Depending upon the form, either the Offeror or the Offeror's engineer shall complete and sign the form to confirm seismic compliance with RP 8. When the engineer fills out a form, he or she is also required to stamp it. The Offeror's engineer shall represent whether the Building meets RP 8 standards, using Form A for Benchmark Buildings or Form B for other existing buildings.

If the engineer's certification indicates that the Building does not meet RP 8 standards, the Offeror shall agree to retrofit the building to meet the standards, using Form C, Part

1. Offerors providing new construction shall commit to a design code, using Form C, Part

2. Offerors may represent that their building meets an exemption criteria, using Form D.

Forms E and F are post-award submittals. They only apply when the Offeror has agreed to either retrofit an existing building (use Form E) or is constructing a new building (use Form F). Prior to the Government accepting leased space, the Lessor's engineer shall complete, stamp, and sign the appropriate representation.

The forms must include the supporting documentation stated in the RLP and Lease.

Below is a detailed explanation of each of the forms.

SEISMIC FORM A - CERTIFICATE OF SEISMIC COMPLIANCE BENCHMARK BUILDING

A benchmark building is one that was designed and built or retrofitted in accordance with structural provisions that are considered to provide acceptable life-safety protection. RP 8, Section 1.3, Table 1-1 shows the construction codes that qualify a building as a Benchmark Building. If a building qualifies, no additional hazards need be considered. If the seismicity of a region has changed since the benchmark dates listed in the table, the building must be evaluated in accordance with the now current or greater seismicity of the region to be compliant with the RP 8 Standards.

SEISMIC FORM B - CERTIFICATE OF SEISMIC COMPLIANCE EXISTING BUILDING

The engineer shall evaluate the building to determine compliance with the Life Safety Performance Level. He or she shall use RP 8 Chapter 3 and ASCE/SEI 31 to determine compliance. The evaluation must include the appropriate Structural, Nonstructural, and Geologic Site Hazard and Foundation Checklists with backup calculations.

SEISMIC FORM C - BUILDING RETROFIT OR NEW CONSTRUCTION PRE-AWARD

COMMITMENT

Part 1 only applies to planned retrofit of an existing building. The Offeror shall identify the engineer in charge of the seismic retrofit and commit that the retrofit's design and construction will conform to the requirements of ASCE/SEI 41, Basic Safety Objective.

The commitment must also include a Tier 1 report with supporting documentation, a narrative, scope, and schedule of the proposed renovations .

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Attachment 2: Seismic Offer Forms <Y

Part 2 only applies to new construction . The Offeror shall identify the engineer in charge of the design of the building and specify which building code he or she is using to design and construct.

SEISMIC FORM D - OFFEROR'S REPRESENTATION OF EXEMPTION FROM SEISMIC

STANDARDS

The Offeror may claim an exemption from seismic compliance if representing that the offered building meets either of the following exemptions:

• In an area of moderate seismicity, the total space leased in the building by the Federal government, including the offered space, will be less than 10,000 ABOA SF upon commencement of the lease term.

• In an area of high to very high seismicity, the offered building is a one-story building of steel light frame or wood construction with less than 280 m2 (3,000

ABOA SF).

SEISMIC FORM E - CERTIFICATE OF SEISMIC COMPLIANCE RETROFITTED BUILDING

The engineer in charge of the building's structural retrofit of the leased building shall certify that the design standard was the Basic Safety Objective as set forth in ASCE/SEI 41, Seismic Rehabilitation of Existing Buildings, and that the building was retrofitted to that standard.

SEISMIC FORM F - CERTIFICATE OF SEISMIC COMPLIANCE NEW BUILDING

The engineer shall certify that the design and construction of new buildings or additions to existing buildings conforms to the seismic provisions of the latest edition of the applicable State or local government codes under which it was built.

DEFINITIONS - The following definitions apply to the completion of the above-referenced forms:

1. Engineer means a professional engineer who is licensed in Civil or Structural Engineering and qualified in the structural design of buildings. They must be licensed in the state where the property is located.

2. ASC E/SEI 31 means the American Society of Civil Engineers standard, Seismic Evaluation of Existing Buildings." ASCE/SEI 31 can be purchased from ASCE at

(800) 548-2723, or by visiting http://www.pubs.asce.org .

3. ASCE/SEI41 means American Society of Civil Engineers standard, Seismic Rehabilitation of Existing Buildings." ASCE/SEI 41 can be purchased from ASCE at (800) 548-2723, or by visiting http://www.pubs.asce.org.

4. Seismic Certificate means a certificate executed and stamped by an Engineer on the appropriate Certificate of Seismic Compliance form included with this solicitation together with any required attachments.

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5. RP 8 means "Standards of Seismic Safety for Existing Federally Owned and Leased Buildings ICSSC Recommended Practice 8 (RP 8)," issued by the Interagency Committee on Seismic Safety in Construction as ICSSC RP 8 and the National Institute of Standards and Technology as NIST GCR 11 -917-12.

You can obtain RP 8 from the Building and Fire Research Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, or download copy athttp://www.wbdg .org/ccb/NIST/nist_gcr11 _917_12.pdf.

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Appendix G:Seismic Safety in Leasing

SEISMIC FORM A

CERTIFICATE OF SEISMIC COMPLIANCE

BENCHMARK BUILDING

Date: ____

This affirms that ___________ served as engineer in charge of the seismic evaluation of the building located at ____________________

The building has the following characteristics:

~SCE Building Type: No. of Stories: IApprox. Area :

Building Design Code: Year of Design Code: lYear of Construction :

On the basis of the building characteristics and to the extent permitted by this level of evaluation, it is my opinion that the subject Building qualifies as a Benchmark Building as indicated in ASCE/SEI 31, Table 1-1 .

Affix Stamp and Sign Here

Engineer's Name:

Firm:

Address:

Telephone:

License No.:

License State:

Expiration Date:

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SEISMIC FORM B

EXISTING BUILDING

Date: _____

This affirms that __----,--________ served as engineer in charge of the seismic evaluation of the building located at ____________________

The building has the following characteristics:

fi\SCE Building Type: No. of Stories: Approx. Area :

Building Design Code: Year of Design Code: Year of Construction:

I have evaluated this building at the Life Safety Performance Level as set forth in the ICSSC RP 8, Standards of Seismic Safety for Existing Federally Owned and Leased Buildings, using ASCE/SEI 31 methodology:

_Tier 1 Evaluation

_ Tier 2 Evaluation

_Tier 3 Evaluation

_ Other (please explain below)

Documentation of this evaluation must be attached to this Certificate.

On the basis of the building characteristics and to the extent permitted by this level of evaluation it is my opinion that subject Building (check one) 0 does / 0 does not meet the Life Safety Performance Level of ICSSC RP 8.

Affix Stamp and Sign Here

Engineer's Name:

Firm:

Address:

Telephone:

License State:

Comments:

Attach : ASCE/SEI 31 Checklist(s) Structural , Nonstructural, and Geologic Site Hazards and Foundation.

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SEISMIC FORM C

BUILDING RETROFIT OR NEW CONSTRUCTION

PREAWARD COMMITMENT

PART 1

PREAWARD COMMITMENT TO RETROFIT BUILDING:

Date: _____

This affirms that shall serve as the engineer in charge of the seismic retrofit of the building located at . The retrofit must be designed to meet the Basic Safety Objective, as set forth in ASCE/SEI 41 Seismic Rehabilitation of Existing Buildings.

In accordance with the requirements of this Standard and the seismic paragraph in the Request for Lease Proposals (RLP), our offer includes a commitment to retrofit the building to satisfy all of the Basic Safety Objective requirements of ASCE/SEI 41 . The offer includes a Tier 1 report with all supporting documents, a narrative explaining the process, scope of renovations, and a schedule for the seismic retrofit.

Documentation shall be provided before award that demonstrates the seismic retrofit will meet the seismic standards and be completed within the time frame required.

PART 2

PREAWARD COMMITMENT TO CONSTRUCT A NEW BUILDING:

Date: _____

This affirms that _----:_________ will serve as the engineer in charge of the structural design of the building located at . The criteria for design must be the ___ edition of the __________ building code.

In accordance with the requirements of this code, we prepared a quality assurance plan that included requirements for testing and inspecting critical elements of the structure and also periodic observation by our staff. We reviewed special inspection and testing reports prepared by the inspection agency and contractor submittals. On the basis of this, and to the extent permitted by this level of construction surveillance, it is my opinion that the Building was designed and constructed in conformance with the requirements of the above code.

The building has the following characteristics:

Building Type: Building Height: ~pprox . Area:

Building Design Code: [Year of Design Code: Year of Construction:

OFFEROR

SIGNATURE INAME OF SIGNER

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SEISMIC FORM D

OFFEROR'S REPRESENTATION OF EXEMPTION FROM SEISMIC STANDARDS

Date: ____

I represent that my building is exempt from the requirements of RP 8 because:

D The Building is located in an area of medium seismicity and the Building will have less than 10,000 ABOA SF of space leased to the Federal Government upon commencement of the lease term.

D The Building is located in an area of high to very high seismicity, and it is a one-story building with a steel light frame or wood construction with less than 3,000 ABOA SF of space in the building.

OFFEROR

SIGNATURE iAM' 0' "0""

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SEISM IC FORM E

RETROFITTED BUILDING

PRE-OCCUPANCY CERTIFICATE:

Date: _____

This affirms that served as the engineer in charge of the structural retrofit of the building located at . The standard for design was the Basic Safety Objective as set forth in ASCE/SEI 41 Seismic Rehabilitation of Existing Buildings.

In accordance with this Standard, we prepared a quality assurance plan, which requires staff to observe, test, and inspect the seismic retrofit work. We have also reviewed special inspection and testing reports prepared by the inspection agency and contractor submittals. On the basis of this, and to the extent permitted by this level of construction surveillance, it is my opinion that building was designed and constructed to conform with the requirements of the Standard listed above.

The building has the following characteristics:

IASCE Building Type: No. of Stories: Approx. Area:

Building Design Code : Year of Design Code: Year of Construction:

Retrofit Design Standard: Year of Retrofit Standard: Year of Retrofit:

Documentation of this retrofit must be available to GSA.

On the basis of the above, it is my opinion that subject Building _ does, _ does not meet the Basic Safety Objective - Performance Level as set forth in ASCE/SEI 41, Seismic Rehabilitation of Existing Buildings.

Affix Stamp and Sign Here

Engineer's Name:

State:

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SEISMIC FORM F

NEW BUILDING

PRE-OCCUPANCY CERTIFICATE:

Date: ____ _

This affirms that served as the engineer in charge of the structural design of the building located at ___________. The criteria for design were the edition of the _____ ____ code.

In accordance with the requirements, we prepared a quality assurance plan, which requires staff to observe, test, and inspect the structure's critical elements. We have also reviewed special inspection and testing reports prepared by the inspection agency and contractor submittals. On the basis of this, and to the extent permitted by this level of construction surveillance, it is my opinion that the building was designed and constructed to conform with the requirements of the code listed above.

The building has the following characteristics:

Building Type: Bldg . Height: Approx. Area:

Building Design Code: lYear of Design Code: Year of Construction:

Affix s tamp and sign here

Engineer's Name:

State:

Comments :

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