Space Safety Environmental Checklist.docx

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__________________

Controlled Entry Alarm System Guard Other_______________________

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

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.

LEED Energy Star Green Globes Other, describe_____________

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

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

Space is separately metered to track tenant water usage

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 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:____________

2.6.11 Checklist: Space Safety and Environmental

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