+------------------------+---+-------+---+--------+---+-----+------------+
| ## General Information |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Agency Requesting    |   |       | * |        |   |     |            |
| Space**                |   |       | * |        |   |     |            |
|                        |   |       | S |        |   |     |            |
|                        |   |       | u |        |   |     |            |
|                        |   |       | r |        |   |     |            |
|                        |   |       | v |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | y |        |   |     |            |
|                        |   |       | L |        |   |     |            |
|                        |   |       | o |        |   |     |            |
|                        |   |       | c |        |   |     |            |
|                        |   |       | a |        |   |     |            |
|                        |   |       | t |        |   |     |            |
|                        |   |       | i |        |   |     |            |
|                        |   |       | o |        |   |     |            |
|                        |   |       | n |        |   |     |            |
|                        |   |       | * |        |   |     |            |
|                        |   |       | * |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
|                        |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Realty Specialist**  |   |       | * |        |   |     |            |
|                        |   |       | * |        |   |     |            |
|                        |   |       | A |        |   |     |            |
|                        |   |       | g |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | n |        |   |     |            |
|                        |   |       | c |        |   |     |            |
|                        |   |       | y |        |   |     |            |
|                        |   |       | R |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | p |        |   |     |            |
|                        |   |       | r |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | s |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | n |        |   |     |            |
|                        |   |       | t |        |   |     |            |
|                        |   |       | a |        |   |     |            |
|                        |   |       | t |        |   |     |            |
|                        |   |       | i |        |   |     |            |
|                        |   |       | v |        |   |     |            |
|                        |   |       | e |        |   |     |            |
|                        |   |       | * |        |   |     |            |
|                        |   |       | * |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
|                        |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Amount of Space/Sq.  |   | **T   |   |        |   | **D |            |
| Ft.**                  |   | ype** |   |        |   | ate |            |
|                        |   |       |   |        |   | of  |            |
|                        |   |       |   |        |   | Su  |            |
|                        |   |       |   |        |   | rve |            |
|                        |   |       |   |        |   | y** |            |
+------------------------+---+-------+---+--------+---+-----+------------+
|                        |   |       |   |        |   |     |            |
|                        |   | **Off |   |        |   |     |            |
|                        |   | ice** |   |        |   |     |            |
|                        |   | **W   |   |        |   |     |            |
|                        |   | areho |   |        |   |     |            |
|                        |   | use** |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
|                        |   | **    |   |        |   |     |            |
|                        |   | Speci |   |        |   |     |            |
|                        |   | al\_\ |   |        |   |     |            |
|                        |   | _\_\_ |   |        |   |     |            |
|                        |   | \_\_\ |   |        |   |     |            |
|                        |   | _\_\_ |   |        |   |     |            |
|                        |   | \_\_\ |   |        |   |     |            |
|                        |   | _\_\_ |   |        |   |     |            |
|                        |   | \_\_\ |   |        |   |     |            |
|                        |   | _\_** |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| #                      |   |       |   |        |   |     |            |
| # Building Information |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Building Name**      | * |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
|                        | B |       |   |        |   |     |            |
|                        | u |       |   |        |   |     |            |
|                        | i |       |   |        |   |     |            |
|                        | l |       |   |        |   |     |            |
|                        | d |       |   |        |   |     |            |
|                        | i |       |   |        |   |     |            |
|                        | n |       |   |        |   |     |            |
|                        | g |       |   |        |   |     |            |
|                        | A |       |   |        |   |     |            |
|                        | d |       |   |        |   |     |            |
|                        | d |       |   |        |   |     |            |
|                        | r |       |   |        |   |     |            |
|                        | e |       |   |        |   |     |            |
|                        | s |       |   |        |   |     |            |
|                        | s |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
|                        |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Owner/Agent Name**   | * |       |   |        |   |     | **Phone    |
|                        | * |       |   |        |   |     | \#**       |
|                        | A |       |   |        |   |     |            |
|                        | d |       |   |        |   |     |            |
|                        | d |       |   |        |   |     |            |
|                        | r |       |   |        |   |     |            |
|                        | e |       |   |        |   |     |            |
|                        | s |       |   |        |   |     |            |
|                        | s |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
|                        |   |       |   |        |   |     | ( )        |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Space Available**    |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Floor \#**           | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
|                        | C |       |   |        | A |     |            |
|                        | o |       |   |        | m |     |            |
|                        | m |       |   |        | o |     |            |
|                        | m |       |   |        | u |     |            |
|                        | o |       |   |        | n |     |            |
|                        | n |       |   |        | t |     |            |
|                        | A |       |   |        | * |     |            |
|                        | r |       |   |        | * |     |            |
|                        | e |       |   |        | ( |     |            |
|                        | a |       |   |        | S |     |            |
|                        | F |       |   |        | q |     |            |
|                        | a |       |   |        | . |     |            |
|                        | c |       |   |        | F |     |            |
|                        | t |       |   |        | t |     |            |
|                        | o |       |   |        | ) |     |            |
|                        | r |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
|                        | * |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **a.**                 | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
|                        | a |       |   |        | a |     |            |
|                        | . |       |   |        | . |     |            |
|                        | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **b.**                 | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
|                        | b |       |   |        | b |     |            |
|                        | . |       |   |        | . |     |            |
|                        | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **c.**                 | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
|                        | c |       |   |        | c |     |            |
|                        | . |       |   |        | . |     |            |
|                        | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **d.**                 | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
|                        | d |       |   |        | d |     |            |
|                        | . |       |   |        | . |     |            |
|                        | * |       |   |        | * |     |            |
|                        | * |       |   |        | * |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Asking Price**       |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **a. Rent/month        |   |       |   |        |   |     |            |
| \$                     |   |       |   |        |   |     |            |
| **\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| **or**                 |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **Rent/sq. ft per      |   |       |   |        |   |     |            |
| Year** (note type of   |   |       |   |        |   |     |            |
| measurement being      |   |       |   |        |   |     |            |
| used)                  |   |       |   |        |   |     |            |
| **\$**\_\_\_\_\_\_\_   |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **b. Services &        |   |       |   |        |   |     |            |
| Utilities              |   |       |   |        |   |     |            |
| Included:\_\_\_        |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **c. Alterations       |   |       |   |        |   |     |            |
| Include                |   |       |   |        |   |     |            |
| d:\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **\_\_\_\_\_\_         |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **\_\_\_\_\_\_         |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **d. Allowance for     |   |       |   |        |   |     |            |
| Tenant Improvements**  |   |       |   |        |   |     |            |
| (per sq. ft.) **:      |   |       |   |        |   |     |            |
| \$\_\_\_\_\_\_\_       |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **e. Other             |   |       |   |        |   |     |            |
| Remarks:\_\_\_\_       |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **\_\_\_\_\_\_         |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| **\_\_\_\_\_\_         |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_** |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Building Location**  |   |       |   | **     |   |     |            |
|                        |   |       |   | Zoning |   |     |            |
|                        |   |       |   | Co     |   |     |            |
|                        |   |       |   | nforms |   |     |            |
|                        |   |       |   | to     |   |     |            |
|                        |   |       |   | Govt.  |   |     |            |
|                        |   |       |   | Use**  |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| **Central Business     |   |       |   |        |   |     |            |
| Dist** **Commercial**  |   |       |   | *      |   |     |            |
|                        |   |       |   | *Yes** |   |     |            |
| **Office Park**        |   |       |   | **No** |   |     |            |
| **Industrial**         |   |       |   |        |   |     |            |
|                        |   |       |   | #      |   |     |            |
| #  Urba                |   |       |   |        |   |     |            |
| n Renewal  Residential |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| # Historical           |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+
| # a. Building Age:     |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| #                      |   |       |   |        |   |     |            |
| b. On Register: \_\_\_ |   |       |   |        |   |     |            |
| \_\_\_\_\_\_\_\_\_\_\_ |   |       |   |        |   |     |            |
|                        |   |       |   |        |   |     |            |
| #  Ot                  |   |       |   |        |   |     |            |
| her: \_\_\_\_\_\_\_\_\ |   |       |   |        |   |     |            |
| _\_\_\_\_\_\_\_\_\_\_  |   |       |   |        |   |     |            |
+------------------------+---+-------+---+--------+---+-----+------------+

# 

+----------------------------------+-----------------------------------+
| ## Exterior Information          |                                   |
+----------------------------------+-----------------------------------+
| # (Upload                        |                                   |
| Photo to eLease or attaché here) |                                   |
+----------------------------------+-----------------------------------+
| **Appearance of Structure**      | **Appearance of Grounds**         |
+----------------------------------+-----------------------------------+
| #  Excellent  Good  Fair  Poor   | **Excellent** **Good** **Fair**   |
|                                  | **Poor**                          |
+----------------------------------+-----------------------------------+
| # Exterior Building Design       | # Exterior Facing Material        |
+----------------------------------+-----------------------------------+
| #                                | ###  Brick  Concrete  Glass       |
| ##  Urban  Office Park  Suburban |                                   |
|                                  | **Steel** **Marble** **Stone**    |
| **Single-Core** **Multi-core**   |                                   |
|                                  | #  Other\_\_\_\_\_\_\_\_\_\       |
| **Adaptive Re-use**              | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                  |                                   |
| **Free Standing Conversion**     |                                   |
+----------------------------------+-----------------------------------+
| ## Interior Information          |                                   |
+----------------------------------+-----------------------------------+
| # Interior Walls                 |                                   |
+----------------------------------+-----------------------------------+
| **a. Type:**                     |                                   |
|                                  |                                   |
| > **Drywall/Sheetrock**          |                                   |
| > **Plaster**                    |                                   |
| > **O                            |                                   |
| ther\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
| >                                |                                   |
| > (Specify)                      |                                   |
|                                  |                                   |
| **b. Office Space Covering:**    |                                   |
|                                  |                                   |
| > **Paint** **Vinyl**            |                                   |
| > **O                            |                                   |
| ther\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
| >                                |                                   |
| > **Wallpaper** **Panel**        |                                   |
| > (Specify)                      |                                   |
|                                  |                                   |
| **c. Public Areas Covering:**    |                                   |
|                                  |                                   |
| > **Paint** **Vinyl**            |                                   |
| > **O                            |                                   |
| ther\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
| >                                |                                   |
| > **Wallpaper** **Panel**        |                                   |
| > (Specify)                      |                                   |
+----------------------------------+-----------------------------------+
| **Lighting**                     |                                   |
+----------------------------------+-----------------------------------+
| **a. Type:**                     |                                   |
|                                  |                                   |
| **Fluorescent** **Incandescent** |                                   |
| **Parabolic**                    |                                   |
|                                  |                                   |
| **Suspended** **Recessed**       |                                   |
| **Flush**                        |                                   |
|                                  |                                   |
| **b. Height:**                   |                                   |
|                                  |                                   |
| **\_\_\_\_" - \_\_\_\_"**        |                                   |
+----------------------------------+-----------------------------------+
| **Ceiling**                      |                                   |
+----------------------------------+-----------------------------------+
| > **Acoustical** **Tile**        |                                   |
| > **Unfinished**                 |                                   |
|                                  |                                   |
| **Plaster** **Suspended**        |                                   |
| **Other\_\_\_\_                  |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
|                                  |                                   |
| (Specify)                        |                                   |
+----------------------------------+-----------------------------------+
| **Windows**                      |                                   |
+----------------------------------+-----------------------------------+
| **a. In Space Offered:**         |                                   |
|                                  |                                   |
| > **Yes** **No**                 |                                   |
|                                  |                                   |
| **b. Frame:**                    |                                   |
|                                  |                                   |
| > **Wood** **Metal**             |                                   |
| > **Oth                          |                                   |
| er\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
| >                                |                                   |
| > (Specify)                      |                                   |
|                                  |                                   |
| **c. Type:**                     |                                   |
|                                  |                                   |
| > **Fixed** **Double Hung**      |                                   |
| >                                |                                   |
| > **Casement**                   |                                   |
| > **O                            |                                   |
| ther\_\_\_\_\_\_\_\_\_\_\_\_\_** |                                   |
| >                                |                                   |
| > (Specify)                      |                                   |
+----------------------------------+-----------------------------------+

+-----------------------------------------------------------------------+
| ## Floors                                                             |
+-----------------------------------------------------------------------+
| **a. Type:**                                                          |
|                                                                       |
| > **Concrete** **Wood**                                               |
|                                                                       |
| **b. Covering:**                                                      |
|                                                                       |
| > **Vinyl Tile** **Carpet** **Other\_\_\_\_\_\_\_\_\_\_\_\_\_\_**     |
|                                                                       |
| ##  (Specify)                                                         |
+-----------------------------------------------------------------------+
| ## Common Area                                                        |
+-----------------------------------------------------------------------+
| **Floor Load**                                                        |
+-----------------------------------------------------------------------+
| **a. Office Space** (70 lbs/sq. ft)**:**                              |
|                                                                       |
| **Yes** **No**                                                        |
|                                                                       |
| **b. Storage Areas** (100 lbs/sq. ft)**:**                            |
|                                                                       |
| **Yes** **No**                                                        |
+-----------------------------------------------------------------------+
| **Toilet Facilities**                                                 |
+-----------------------------------------------------------------------+
| **a. Each floor has separate men's & women's bathrooms:**             |
|                                                                       |
| > **Yes** **No**                                                      |
|                                                                       |
| **b. Travel distance is less than 150'** (per 10,000 sq. ft)**:**     |
|                                                                       |
| > **Yes** **No**                                                      |
|                                                                       |
| **c. Number of Stalls:**                                              |
|                                                                       |
| **Men \_\_\_\_\_\_\_\_\_\_\_ Urinals\_\_\_\_\_\_\_\_\_\_\_**          |
|                                                                       |
| **Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                       |
|                                                                       |
| **d. Number of Sinks:**                                               |
|                                                                       |
| **Men\_\_\_\_\_\_\_\_\_\_\_ Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**             |
|                                                                       |
| **e. Automatic Door Openers:**                                        |
|                                                                       |
| **Men\_\_\_\_\_\_\_\_\_\_\_ Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**             |
|                                                                       |
| ***Measurements:***                                                   |
|                                                                       |
| **a. Door Entrance** (min. 32")**: Men\_\_\_\_\_\_\_\_\_\_\_          |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **b. Door Identification Signs** (min. 54"/max. 66")**:               |
| Men\_\_\_\_\_\_\_\_\_\_\_ Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**               |
|                                                                       |
| **c. Vestibules** (min. 48" not including door swing)**:              |
| Men\_\_\_\_\_\_\_\_\_\_\_ Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**               |
|                                                                       |
| **d. Light Switches** (min. 42"/max 54")**: Men\_\_\_\_\_\_\_\_\_\_\_ |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **e. Sink Clearance** (min. 29")**: Men\_\_\_\_\_\_\_\_\_\_\_         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **f. To Sink Countertop** (max. 34")**: Men\_\_\_\_\_\_\_\_\_\_\_     |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **g. Stall Door** (32" swings out)**: Men\_\_\_\_\_\_\_\_\_\_\_       |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **h. To Sink Countertop** (max. 34")**: Men\_\_\_\_\_\_\_\_\_\_\_     |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **i. Stall Door** (32" swings out)**: Men\_\_\_\_\_\_\_\_\_\_\_       |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| ***Faucets:***                                                        |
|                                                                       |
| **a. Lever or Push: Men\_\_\_\_\_\_\_\_\_\_\_                         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **b. Door Swing Measurement: Men\_\_\_\_\_\_\_\_\_\_\_                |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **c. Turning Diameter** (5')**:** **Men\_\_\_\_\_\_\_\_\_\_\_         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **d. Pipes Insulated** (Hot water & drain)**:                         |
| Men\_\_\_\_\_\_\_\_\_\_\_ Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**               |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Toilet Facilities (cont.)**                                         |
+-----------------------------------------------------------------------+
| ***Accessories (towels, soap, etc):***                                |
|                                                                       |
| **a. Front Approach** (max. 48")**: Men\_\_\_\_\_\_\_\_\_\_\_         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **b. Side Approach** (max. 54")**: Men\_\_\_\_\_\_\_\_\_\_\_          |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **c. Mirror Shelf: Men\_\_\_\_\_\_\_\_\_\_\_                          |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **d. Soap Reach: Men\_\_\_\_\_\_\_\_\_\_\_                            |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| ***Stalls:***                                                         |
|                                                                       |
| **a. Wall Mounted** (60" x 56")**: Men\_\_\_\_\_\_\_\_\_\_\_          |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **b. Floor Mounted** (60" x 59")**: Men\_\_\_\_\_\_\_\_\_\_\_         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| (36" x 69")**: Men\_\_\_\_\_\_\_\_\_\_\_                              |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **c. Alternate** (36" x 69")**: Men\_\_\_\_\_\_\_\_\_\_\_             |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **d. Urinals** (Elongated Lip 17" max)**: Men\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **Height of Flush Valve (**44" max)**: Men\_\_\_\_\_\_\_\_\_\_\_**    |
|                                                                       |
| **e. Toilets** (min 17" max 19")**: Men\_\_\_\_\_\_\_\_\_\_\_         |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **f. Handrails** (min 33" max 36")**: Men\_\_\_\_\_\_\_\_\_\_\_       |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **Diameter** (1.25" -- 1.5") **: Men\_\_\_\_\_\_\_\_\_\_\_            |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **Location** (each side, side & rear)**: Men\_\_\_\_\_\_\_\_\_\_\_    |
| Women­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| **g.                                                                  |
| Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\              |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| **\_                                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
+-----------------------------------------------------------------------+
| #### Drinking Fountains                                               |
+-----------------------------------------------------------------------+
| **a. Drinking Fountains per Floor:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**    |
|                                                                       |
| **b. Travel distance is less than 150'** (per 10,000 sq. ft)**:**     |
| **Yes** **No**                                                        |
|                                                                       |
| **c. Alcove:** **Yes** **No**                                         |
|                                                                       |
| **d. Clear Floor Space** (30" x 48")**:** **Yes** **No**              |
|                                                                       |
| **e. Clearance** (27")**:** **Yes** **No**                            |
|                                                                       |
| **f. Height of Spout Control** (max. 36" above floor)**:** **Yes**    |
| **No**                                                                |
|                                                                       |
| **g. Handicap Accessible:** **Yes** **No** **Can be Altered**         |
|                                                                       |
| **h.                                                                  |
| Comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\            |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
+-----------------------------------------------------------------------+
| # Under Floor Ducts                                                   |
+-----------------------------------------------------------------------+
| #  Yes  No                                                            |
+-----------------------------------------------------------------------+
| # Heating                                                             |
+-----------------------------------------------------------------------+
| **a. Type:** **Warm Air** **Hot Air** **Steam**                       |
|                                                                       |
| **b. Fuel:** **Electric** **Oil** **Gas**                             |
| **Other\_\_\_\_\_\_\_\_\_\_**                                         |
|                                                                       |
| (Specify)                                                             |
+-----------------------------------------------------------------------+
| #### Air Conditioning                                                 |
+-----------------------------------------------------------------------+
| **a. Type:** **Central** **Package** **Window**                       |
|                                                                       |
| **b. Fuel:** **Electric** **Gas** **Other\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| (Specify)                                                             |
+-----------------------------------------------------------------------+

+----------------------------------+-----------------------------------+
| **Public Telephones** (if        |                                   |
| provided)                        |                                   |
+----------------------------------+-----------------------------------+
| **a. Front Approach** (max.      |                                   |
| 48")**:\_\_\_\_\_\_\_\_\_\_**    |                                   |
|                                  |                                   |
| **b. Side Approach** (max.       |                                   |
| 54")**:\_\_\_\_\_\_\_\_\_\_**    |                                   |
+----------------------------------+-----------------------------------+
| #### Elevators                   |                                   |
+----------------------------------+-----------------------------------+
| # a. Type:  Automatic  Manual    |                                   |
|                                  |                                   |
| **b. Number:**                   |                                   |
|                                  |                                   |
| #######  Passe                   |                                   |
| nger\_\_\_\_\_\_\_\_\_\_\_\_\_ F |                                   |
| reight\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| **c. Current Certificate of      |                                   |
| Inspection:** **Yes** **No**     |                                   |
|                                  |                                   |
| **d. Opening** (min. 36" )       |                                   |
| **:\_\_\_\_\_\_\_\_\_\_**        |                                   |
|                                  |                                   |
| **e. Depth** (min. 51" )         |                                   |
| **:\_\_\_\_\_\_\_\_\_\_**        |                                   |
|                                  |                                   |
| **f. Width** (min. 68" )         |                                   |
| **:\_\_\_\_\_\_\_\_\_\_**        |                                   |
|                                  |                                   |
| **g. High Hall Call Cab          |                                   |
| Buttons** (max. 54" )            |                                   |
| **:\_\_\_\_\_\_\_\_\_\_**        |                                   |
|                                  |                                   |
| **h. Two-way Telephone:**        |                                   |
|                                  |                                   |
| **Height** (max. 48" )           |                                   |
| **:\_\_\_\_\_\_\_\_\_\_**        |                                   |
|                                  |                                   |
| **24 Hour Monitor:** **Yes**     |                                   |
| **No**                           |                                   |
|                                  |                                   |
| **i. Inspection Sign Current:**  |                                   |
| **Yes** **No**                   |                                   |
|                                  |                                   |
| **j. Elevator Recall to Lobby:** |                                   |
| **Yes** **No**                   |                                   |
|                                  |                                   |
| **k. Firemen's Capture           |                                   |
| Provides:** **Yes** **No**       |                                   |
+----------------------------------+-----------------------------------+
| #### Outside Air Intake          |                                   |
+----------------------------------+-----------------------------------+
| ####  Roof/Penthouse             |                                   |
| Street Level  Below Street Level |                                   |
|   Other:\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
+----------------------------------+-----------------------------------+
| # Parking                        |                                   |
+----------------------------------+-----------------------------------+
| # Official                       | # Employee                        |
+----------------------------------+-----------------------------------+
| # a.                             | # a.                              |
| Location:  Inside  Outside  None |  Location:  Inside  Outside  None |
|                                  |                                   |
| **b. No. of Spaces:**            | **b. No. of Spaces:**             |
| \_\_\_\_\_\_\_\_\_\_\_           | \_\_\_\_\_\_\_\_\_\_\_            |
|                                  |                                   |
| # c. Rate per Space: \$\_        | # c. Rate per Space: \$\          |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+----------------------------------+-----------------------------------+
| ## Environmental Compliance      |                                   |
+----------------------------------+-----------------------------------+
| # Hazardous Substance            |                                   |
+----------------------------------+-----------------------------------+
| # Was hazardous substance        |                                   |
|  ever conducted on the property? |                                   |
|                                  |                                   |
| #  Yes                           |                                   |
|                                  |                                   |
| #  a. Provide specifics          |                                   |
|  to contamination:\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| # b. Hazardous Material St       |                                   |
| orage:\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| #  c. Hazardous Waste Site:\_\_  |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| #  No                            |                                   |
+----------------------------------+-----------------------------------+
| # Asbestos                       |                                   |
+----------------------------------+-----------------------------------+
| # Was hazardous substance        |                                   |
|  ever conducted on the property? |                                   |
|                                  |                                   |
| #  Yes                           |                                   |
|                                  |                                   |
| #  a.                            |                                   |
| Condition:  Friable  Non-Friable |                                   |
|                                  |                                   |
| # b. Type:                       |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| #  c. Co                         |                                   |
| ntained:\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| #  d. Location (insulation,      |                                   |
|  ceiling, floor tiles, etc):\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                   |
|                                  |                                   |
| #  No                            |                                   |
+----------------------------------+-----------------------------------+

+-----------------------------------------------------------------------+
| # Polychlorinated Biphenyls (PCB)                                     |
+-----------------------------------------------------------------------+
| # Certification:                                                      |
|                                                                       |
| #  Yes                                                                |
|                                                                       |
| #  Provide list of all PCB contain                                    |
| ing equipment and assurance that they will continue to be maintained. |
|                                                                       |
| #  No                                                                 |
|                                                                       |
| #  Provide lis                                                        |
| t of all PCB containing equipment and assurance regarding compliance. |
+-----------------------------------------------------------------------+
| # Underground Storage Tanks (UST)                                     |
+-----------------------------------------------------------------------+
| #  Yes                                                                |
|                                                                       |
| #  Location\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Capacity\_\_\_          |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_ Number\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| #  Certification:                                                     |
|                                                                       |
| #  a. Maintenance\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                   |
|                                                                       |
| #  b. In compliance wit                                               |
| h current UST regulations:  Yes  No When (date)\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| #  No                                                                 |
+-----------------------------------------------------------------------+
| # NEPA                                                                |
+-----------------------------------------------------------------------+
| # Comp                                                                |
| liance: (Coordinate with your Regional Environmental Quality Advisor) |
|                                                                       |
| # \_\_\_\_\_\_\_CATEX Checklist \_\_\_\_\_\_\_EA \_\_\_\_\_\_\_EIS    |
+-----------------------------------------------------------------------+
| # Endangered Species                                                  |
+-----------------------------------------------------------------------+
| # Is ther                                                             |
| e a presence or likely presence of any Federally designated or state  |
| designated threatened or endangered species on the property?  Yes  No |
+-----------------------------------------------------------------------+
| # Wetlands                                                            |
+-----------------------------------------------------------------------+
| # Are there any known wetlands present on the property?  Yes  No      |
|                                                                       |
| GSA should use the appropriate National Wetlands Inventory map to     |
| make this determination.                                              |
+-----------------------------------------------------------------------+
| # Floodplains                                                         |
+-----------------------------------------------------------------------+
| # Is the property located in or adjacent to a floodplain?             |
|                                                                       |
| #  Yes                                                                |
|                                                                       |
| #  100 Years\_\_\_\_\_\_ 500\_\_\_\_\_\_                              |
|                                                                       |
| #  Review information to ensure compliance with state and local laws  |
|                                                                       |
| #  No                                                                 |
+-----------------------------------------------------------------------+
| # Coastal Zone Management                                             |
+-----------------------------------------------------------------------+
| # Will the leasing action affect coastal resources?  Yes  No          |
|                                                                       |
| #                                                                     |
|                                                                       |
| # Federal consistency applies when any direct or l                    |
| ocation affects any land, water, or natural resources of the coastal  |
| zone. No federal activity is exempt from the consistency requirement. |
+-----------------------------------------------------------------------+
| # Traffic Impacts                                                     |
+-----------------------------------------------------------------------+
| #  Lo                                                                 |
| cation (address, lot, & block #)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| a.  **Description** (use add'l sheet if                               |
|     necessary)\_\_\_\_\_\_\_\_\_\_\_\                                 |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| b.  **Is your action likely to change traffic patterns or increase    |
|     traffic volumes?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**              |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| c.  **Have access                                                     |
|     constraints?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| # e                                                                   |
| . Affect a congested intersection?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| f.  **Have access                                                     |
|     constraints?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                                                       |
| #                                                                     |
|  g. Affect a congested intersection?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| # i. Other\_\_\_\_\_\_                                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| #                                                                     |
|                                                                       |
| # Please re                                                           |
| fer to the NEPA Desk Guide for additional examples of traffic impact. |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| # Fire Protection/Occupational Health & Environmental Safety          |
+-----------------------------------------------------------------------+
| ## Security                                                           |
+-----------------------------------------------------------------------+
| ##  No Provisions  Secure Building  Guard in Lobby                    |
|                                                                       |
| ##  Alarm System  Controlled Entry  Card Key System                   |
|                                                                       |
| **24 Hr Guard Service** **Elevator Control (Lockoff)** **Controlled   |
| Garage Entry**                                                        |
|                                                                       |
| **Balconies/Patios Adjacent to Space**                                |
+-----------------------------------------------------------------------+
| ## Emergency Illumination (0.5 Foot Cancles)                          |
+-----------------------------------------------------------------------+
| **a. Office Space** (not always req'd)**:** **Yes** **No**            |
|                                                                       |
| **b. Corridors:** **Yes** **No**                                      |
|                                                                       |
| **c. Stairways:** **Yes** **No**                                      |
+-----------------------------------------------------------------------+
| ## Stairwells                                                         |
+-----------------------------------------------------------------------+
| ## a. Type: Scissors  Open Closed                                     |
|                                                                       |
| ## b. General Information:                                            |
|                                                                       |
| ##                                                                    |
| Stairwell Door Latches  Doors Close Automatically  Discharge Outside  |
|                                                                       |
| ##  Discharge Into Garage  Handrails  Safety Stripping                |
|                                                                       |
| **Stairwell \_\_\_\_\_ ft of space** **Standpipes**                   |
+-----------------------------------------------------------------------+
| #### Spr                                                              |
| inklers (req'd in buildings over 74' tall and basement offered space) |
+-----------------------------------------------------------------------+
| **a. Building Sprinklers:** **Yes** **No**                            |
|                                                                       |
| **b. Corridors only:** **Yes** **No**                                 |
|                                                                       |
| **c. Basement:** **Yes** **No**                                       |
+-----------------------------------------------------------------------+
| #### Fire Safety                                                      |
+-----------------------------------------------------------------------+
| **a. Fire Alarm:** **Manual** **Automatic**                           |
|                                                                       |
| **b. Fire Alarm Above Floor** (min. 42" max.                          |
| 54")**:\_\_\_\_\_\_\_\_\_\_\_**                                       |
|                                                                       |
| **c. Occupant Notification** (i.e. sound, lights)                     |
| **:\_\_\_\_\_\_\_\_\_\_\_\_\_\_**                                     |
|                                                                       |
| **d. Fire Station Link** (i.e. notifies fire station)                 |
| **:\_\_\_\_\_\_\_\_\_\_\_\_\_\_**                                     |
|                                                                       |
| **e. Central Monitoring of Fire Alarm:** **Yes** **No**               |
|                                                                       |
| **f. Fire Extinguishers:** **Yes** **No**                             |
|                                                                       |
| **g. Smoke Detectors:** **Yes** **No**                                |
+-----------------------------------------------------------------------+
| ## Handicap Accessibility                                             |
+-----------------------------------------------------------------------+
| **a. Building Entrance** (door width 32")**:** **Yes** **No** **Can   |
| be Altered**                                                          |
|                                                                       |
| **b. 1:12 Ramps:** **Yes** **No** **Can be Altered**                  |
|                                                                       |
| **c. 1:20 Walks:** **Yes** **No** **Can be Altered**                  |
|                                                                       |
| **d. Curbcut 36":** **Yes** **No** **Can be Altered**                 |
|                                                                       |
| **e. Parking 13' wide** (96" space + 60" access aisle)**:**           |
|                                                                       |
| **Yes** **No** **N/A** **Can be Altered**                             |
|                                                                       |
| **f. Stairs** (not acceptable if no elevator)**:**                    |
| \_\_\_\_\                                                             |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+----------------------+-----------------------+-----------------------+
| ### Handicap A       |                       |                       |
| ccessibility (cont.) |                       |                       |
+----------------------+-----------------------+-----------------------+
| ###                  |                       |                       |
|  g. Light Switches ( |                       |                       |
| min. 42", max 54"):  |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
|                      |                       |                       |
| ### h.               |                       |                       |
|  Vestibules (min. 48 |                       |                       |
| " + door swing"): \_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
+----------------------+-----------------------+-----------------------+
| ### General Comments |                       |                       |
+----------------------+-----------------------+-----------------------+
| \_\_\_               |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
|                      |                       |                       |
| \_\_\_               |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
|                      |                       |                       |
| \_\_\_               |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
|                      |                       |                       |
| \_\_\_               |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
+----------------------+-----------------------+-----------------------+
| ### Select           |                       |                       |
| ion of Award Factors |                       |                       |
+----------------------+-----------------------+-----------------------+
| ####### Possible     | ####### Criteria      | ####### Comments      |
+----------------------+-----------------------+-----------------------+
| ### *[His            | ### *[Use Standard    | ### *[Buil            |
| toric]{.underline}*  |  Clause]{.underline}* | ding eligible for pre |
|                      |                       | ference]{.underline}* |
+----------------------+-----------------------+-----------------------+
| ###                  |                       |                       |
|  Decision to Solicit |                       |                       |
+----------------------+-----------------------+-----------------------+
| ####                 |                       |                       |
| ### a. This building |                       |                       |
|                      |                       |                       |
| #####                |                       |                       |
| ##  \_\_\_\_\_ will  |                       |                       |
| be solicited. It mee |                       |                       |
| ts or is capable of  |                       |                       |
|                      |                       |                       |
| #######  meetin      |                       |                       |
| g the SFO standards. |                       |                       |
|                      |                       |                       |
| **\_\_\_\_\_ will    |                       |                       |
| not be solicited. It |                       |                       |
| does not meet and**  |                       |                       |
|                      |                       |                       |
| **is not capable of  |                       |                       |
| meeting the SFO      |                       |                       |
| standards**          |                       |                       |
|                      |                       |                       |
| **for the following  |                       |                       |
| reason(s):**         |                       |                       |
|                      |                       |                       |
| **b. The client      |                       |                       |
| agency               |                       |                       |
| representative       |                       |                       |
| present on the       |                       |                       |
| market survey**      |                       |                       |
|                      |                       |                       |
| \_\_\_\_\_ **agrees  |                       |                       |
| with the above       |                       |                       |
| decision**           |                       |                       |
|                      |                       |                       |
| \_\_\_\_\_ **does    |                       |                       |
| not agree with the   |                       |                       |
| above decision**     |                       |                       |
|                      |                       |                       |
| **for the following  |                       |                       |
| reason(s):**         |                       |                       |
|                      |                       |                       |
| **\_\_\_\_\_\_       |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_       |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_** |                       |                       |
|                      |                       |                       |
| Agency Rep Title     |                       |                       |
|                      |                       |                       |
| **\_\_\_\_\_\_       |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_       |                       |                       |
| \_\_\_\_\_\_\_\_\_\_ |                       |                       |
| \_\_\_\_\_\_\_\_\_** |                       |                       |
|                      |                       |                       |
| Person Conducting    |                       |                       |
| Survey Title         |                       |                       |
+----------------------+-----------------------+-----------------------+