EXHIBIT Q - ADA Certification.pdf
PDF 152 KB Posted
- Solicitation number
- 36C24W26R0055
- Issued by
-
Department of Veterans Affairs
About this file
This is an ADA Certification form (Exhibit Q) required for federal lease solicitations. The form serves as a certification and declaration document for lessors submitting offers for real property leases to the federal government.
The form contains two primary sections. Section 1 requires the lessor to certify handicapped accessibility compliance by confirming that all requirements set forth in the Solicitation for Offers will be met, with checkboxes to indicate either full compliance ("All sections will be met") or partial non-compliance ("All sections are not met"), with space to specify deficiencies if applicable. Section 2 requires the Lessor/Payee Declaration, capturing critical identification and contact information that would appear on the resultant lease contract, including separate fields for lessor and payee information (name, address, city/state, zipcode, email, telephone, and fax). The form also requires the offeror's signature, company name, and Unique Entity Identification (UEI) Number, with space for the date of submission. Initials from both the lessor and government representative are required at the bottom of the form.
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Text version
EXHIBIT Q – 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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