Space Safety Environmental Certification Attch D.pdf

Federal Aviation Administration Real Estate & Utilities Group Space Safety and Environmental Checklist- 09/2020 Page 1

U.S. Department of Transportation Federal Aviation Administration

CHECKLIST: FAA SAFETY AND ENVIRONMENTAL

CERTIFICATION

INSTRUCTIONS: Complete the following information that applies to the building being offered for lease to the Government.

Building Name:_______________________________________________________________________

Street Address:_________________________________________________________________________

City:_________________________________________, State: ______ Zip Code___________________

Square footage of building___________________, Square footage of proposed space______________

Total number of floors in building_____________, Floors proposed space is on ___________________

Year building constructed __________________, Year of last major renovation__________________

ITEM CONDITION YES NO

SECURITY Secure access provided (check all that apply):

Controlled Entry Alarm System Guard

Other_______________________

FIRE AND LIFE

SAFETY

The building has obtained an Occupancy Permit from the local authority having jurisdiction (provide copy of permit).

OR

Reply to the items below:

Two means of egress are provided from the space offered for lease

Exits are clearly marked with illuminated exit signs

If space is above or below grade level, stairwell doors open in direction of egress discharging outside or into a protected fire corridor that discharges outside.

Automated sprinklers are provided (Sprinklers are mandatory if any portion of the offered space is on or above the sixth floor or below grade.)

Operable employee alarm system is provided

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ITEM CONDITION YES NO

SEISMIC

PROTECTION

Space is designed, built and maintained to the requirements of seismic standards (check relevant standard and provide supporting documentation, including government-provided “Life Safety Compliance/Seismic Certification” form):

ICSSC RP-8, Seismic Standards for Existing Federally Owned and Leased Buildings, Dec 2011

American Society for Civil Engineers (ASCE) 31-03, Seismic Evaluation of Existing Buildings

Building qualifies as “Benchmark Building” under RP-8

If answer is no, LOB concurrence will be required prior to lease execution.

ASBESTOS

Space is free of all asbestos-containing materials (check basis of statement and provide supporting documentation):

Asbestos survey

Asbestos-free construction certification

If building is known or presumed to contain asbestos, the lessor has an asbestos management program in place and asbestos locations have proper signage.

RADON The space has been tested for radon and found to test under 4.0 picocuries per milliliter (provide copy of radon test results).

DRINKING WATER Building drinking water has been tested and found to meet the standards prescribed in Safe Drinking Water Act (provide copy of water test results).

GENERAL

SUSTAINABILITY

Building has third-party sustainability certification. If yes, check which applies:

LEED Energy Star Green Globes

Other, describe_____________

ENERGY

CONSERVATION

Building/space uses EnergyStar appliances (e.g., heating and air conditioning equipment, refrigerators, etc.)

Other energy conserving measures have been implemented (such as occupancy sensors, energy efficient lighting, weatherization, solar water heaters). If yes, please describe measures below:

Space is separately metered to track tenant energy usage

WATER

CONSERVATION

Building/space uses WaterSense or other water conserving fixtures (e.g., faucets, toilets, etc.)

Building landscaping uses native vegetation and/or no irrigation is provided

Space is separately metered to track tenant water usage

OTHER

ENVIRONMENTAL

CONCERNS

Waste recycling is provided

If janitorial services are provided, green cleaning products are specified and used

Owner or Authorized Representative Signature The information provided by the offeror on this form is material facts and representations upon which the Government relies for making an award. The Government has the right to require remedy if the information is in any way misrepresented, or inaccurate. The owner or authorized representative certifies that all the features described above are in operating order and properly maintained. Owner/authorized representative acknowledges that this document in no way commits the

Space Safety and Environmental Checklist- 09/2020 Page 3

Government to enter into any agreement or contract with this offeror with respect to this or any other property. The information provided will be used by the Government to evaluate potential properties.

OWNER OR AUTHORIZED REPRESENTATIVE NAME AND ADDRESS:

SIGNATURE:_______________________________________________DATE:____________