EXHIBIT O - ADA Certification.pdf
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- Solicitation number
- 36C24W24R0121
- Issued by
-
Department of Veterans Affairs
About this file
This document is an ADA Certification form related to a Request for Lease Proposals (RLP) for a new Department of Veterans Affairs (VA) Community Based Outpatient Clinic (CBOC) in Parker County, Texas. The RLP seeks approximately 14,500 to 15,500 ABOA square feet of clinical space with at least 125 on-site parking spaces, available for occupancy by June 2025. The proposed lease term is 10 years, with 5 years firm. The lessor must certify that all ADA requirements will be met, and provide their company information, including the Unique Entity Identification (UEI) number. This is a required form to be submitted with the offer in response to the RLP.
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Text version
RLP#: 36C24W24R0121 – EXHIBIT O – ADA CERTIFICATION
INITIALS: LESSOR: ________ GOVERNMENT: ________
ADA CERTIFICATION
1. HANDICAPPED ACCESSIBILITY:
By submission of this offer, the lessor certifies that all requirements set forth in the Solicitation for Offers will be met unless otherwise stated.
_____All sections will be met _____All sections are not met (please specify below)
2. LESSOR/PAYEE DECLARATION
In the event the offer being submitted herein is the successful offer, the Lessor/Payee name and address to be reflected on the resultant Lease Contract would be as follows:
LESSOR
NAME: __________________________________
ADDRESS: __________________________________
CITY/STATE: __________________________________
ZIPCODE: __________________________________
EMAIL: __________________________________
TELEPHONE: __________________________________
FAX: __________________________________
OFFEROR’S SIGNATURE (Owner or Agent)
NAME OF COMPANY
UNIQUE ENTITY IDENTIFICATION (UEI Number)
PAYEE
DATE
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