Space Safety Environmental Checklist.docx

OMB Control No. 2120-0595 Department of Transportation Federal Aviation Administration

Checklist: FAA Space Safety & Environmental Certification

IN RESPONSE TO ANNOUNCEMENT/ LEASE CONTRACT #:

697DCM-24-L-00048

Jonesboro, AR Date: MM/DD/YYYY

Paperwork Reduction Act Burden Statement A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0595. Public reporting for this collection of information is estimated to be approximately 120 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

INSTRUCTIONS: Offeror must fill in all applicable boxes and provide to the Real Estate Contracting Officer with the response to the solicitation. Any attachments should be listed in the appropriate “remarks” section.

SECURITY ACCESS-

FSL X

The offered property provides or will be constructed to provide secure access via (check all that apply):

☐Controlled Entry ☐ Guard ☐ Alarm

☐ Other (describe in remarks below and attach additional documentation as needed)

OR

☐Offered space does not provide secure access as required in the solicitation/lease.

SECURITY ACCESS REMARKS:

Click or tap here to enter text.

LIGHTING

FSL X

The offered property (including offered parking):

☐ Meets minimum lighting requirements stated in the solicitation/lease.

☐ Will be constructed/renovated to meet lighting requirements statement in the solicitation/lease.

☐ Does not meet lighting requirements.

FIRE AND LIFE SAFETY

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

☐ The building will obtain an Occupancy Permit from the local authority having jurisdiction prior to the stated occupancy date in the solicitation.

OR

☐ If the Occupancy Permit is not available or the local jurisdiction does not issue Occupancy Permits, a report prepared by a licensed fire protection engineer with their assessment of the offered Space regarding compliance with all applicable local Fire Protection and Life Safety-related codes and ordinances is attached to address each of the items shown 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

ACCESSIBILITY

The offered property (including offered parking):

☐ Meets Accessibility Standards stated in the solicitation/lease ☐ Will be constructed/renovated to meet Accessibility Standards stated in the solicitation/lease ☐ Does not meet Accessibility Standards stated in the solicitation/lease.

SEISMIC PROTECTION

☐ Solicitation does not contain seismic requirements. No documentation required.

☐ Solicitation contains seismic requirements. The space is designed, built and maintained to the requirements of seismic standards (check relevant standard and provide supporting documentation, including the “Life Safety Compliance/Seismic Certification” form):

The space fully meets seismic requirements or meets an exemption as follows:

☐ National Institute of Standards & Technology (NIST), Standards for Seismic Safety for Existing Federally Owned or Leased Buildings (“the Standards”) as amended.

☐ American Society for Civil Engineers (ASCE) 41-13, Seismic Evaluation AND Retrofit of Existing Buildings.

☐ Building qualified as a “Benchmark Building” under the Standards.

☐ Does not meet seismic requirements, but will be retrofitted to meet seismic requirements described in the solicitation/lease.

☐ Will be constructed to meet seismic requirements.

☐ Will not meet seismic requirements*

FLOOD PLAINS

The offered property is:

☐ in a base (100-year) flood plain ☐ not in a flood plain

ASBESTOS-CONTAINING MATERIALS (ACM)

The offered property is free of all asbestos-containing materials (ACM) (check basis of statement and provide supporting documentation):

☐ Asbestos Survey ☐ Asbestos-free construction certification

OR

☐ Offered property is known or presumed to contain ACM not in a stable, solid matrix. (Offeror must provide documentation that an asbestos management program is in place and that asbestos locations have proper signage as deemed acceptable to the Real Estate Contracting Officer (RECO)).

☐ Offered property does not meet stated Asbestos Requirements in the Solicitation/Lease.

ACM REMARKS:

RADON

The offered property:

☐ Has been tested for radon and found to test under 4.0 picocuries per milliliter (provide copy of radon test results).

☐ Will be constructed/renovated to meet radon requirements stated in the solicitation/lease.

☐ Does not meet radon requirements.

DRINKING WATER

The offered property’s drinking water:

☐ Has been tested and found to meet the standards prescribed in Safe Drinking Water Act (provide copy of water test results).

☐ Will be constructed/renovated to meet Drinking Water requirements stated in the solicitation/lease.

☐ Does not meet Drinking Water requirements.

GENERAL SUSTAINABILITY

Check all that apply:

☐ Solicitation does not contain sustainability requirements.

☐ The offered space does not have third-party sustainability certification.

The offered space has third-party sustainability certification (check appropriate one(s) below).

☐ LEED (indicate level in remarks below) ☐ Green Globes ☐ Other (describe in remarks below)

The offered space will earn third-party sustainability certification prior to stated occupancy date within the solicitation.

☐ LEED (indicate level in remarks below) ☐ Green Globes ☐ Other (describe in remarks below)

SUSTAINABILITY REMARKS:

ENERGY CONSERVATION

Check all that apply:

☐ Solicitation does not contain Energy Star requirements.

The Building:

☐ Has received the ENERGY STAR® Label within the past twelve months.

Date ___________________

☐ Will earn the ENERGY STAR® Label within one year of signing the lease.

OR

☐ Is of historical, architectural, or cultural significance verified by listing or eligibility for listing on the National Register of Historic Places (attach documentation).

☐ The lease premises will be less than 10,000 gross SF.

☐ Building/space uses Energy Star 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, describe measures in remarks below.

☐ Space is separately metered to track tenant energy usage

ENERGY CONSERVATION REMARKS:

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

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

☐ Offered Space is separately metered to track tenant water usage

☐ Solicitation does not include janitorial requirements. No documentation required.

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

☐ The offered property is free of hazardous conditions or environmental releases.

☐ The offered property has known hazardous conditions and/or environmental releases as described on the attached documentation (NOTE: Environmental Documentation is subject to review and approval by the appropriate FAA Environmental Subject Matter Expert).

If NO, additional documentation must be provided and approved by the appropriate FAA Environmental Subject Matter Expert.

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:____________

Federal Aviation Administration Space Safety Environmental Checklist, 10/2022 FAA Form 4400-92