Fillable Printable Revocable License For Non-Federal Use Of Real Property

Revocable License For Non-Federal Use Of Real Property

REVOCABLE LICENSE FOR NON-FEDERAL USE OF REAL PROPERTY

1. LICENSE NO.

A revocable license affecting the property described and for the purpose designated below is hereby granted to the licensee herein named,

subject to all of the conditions, special and general, hereinafter enumerated.

2. NAME OF LICENSEE 3. ADDRESS

4. PROJECT DESIGNATION AND ADDRESS

5. MAXIMUM PERIOD COVERED

FROM TO

6. CONSIDERATION ($)

7. DESCRIPTION OF PROPERTY AFFECTED

8. PURPOSE OF LICENSE

9. By the acceptance of this license, the licensee agrees to abide and be bound by the following conditions:

I. SPECIAL CONDITIONS

That condition(s) No.(s)

GENERAL SERVICES ADMINISTRATION LICENSOR

LICENSEE

DATED (Month, day, year) ACCEPTED (Month, day, year)

BY (Signature) BY (Signature)

NAME NAME

TITLE TITLE

If License is a Corporation, the following Certificate of Licensee must be executed:

CERTIFICATE OF CORPORATE LICENSEE

I certify that I was a Secretary of the corporation named as licensee herein; that the person who signed said license on behalf of the

licensee was with said corporation; and that said license was duly signed for and in behalf of said corporation by authority of its

governing body, and is within the scope of its corporate powers.

NAME OF CERTIFIER

TITLE OF CERTIFIER

NAME OF LICENSE SIGNER

TITLE OF LICENSE SIGNER

(CORPORATE SEAL)

SIGNATURE OF CERTIFIER

GENERAL SERVICES ADMINISTRATION

PREVIOUS EDITION IS NOT USABLE

GSA FORM 1582 (REV. 10/2013)

(See reverse)

(As shown on Exhibit

, attached hereto and made a part hereof.)

was (were) deleted before the execution of this license.

II. GENERAL CONDITIONS

a. COMPLIANCE. Any use made of property affected by the

license, and any construction, maintenance, repair, or other

work performed thereon by the licensee, including the

installation and removal of any article or thing, shall be

accomplished in a manner satisfactory to the General Services

Administration, hereinafter referred to as GSA.

b. STRUCTURES. The license shall not place or construct

upon, over or under the property and installation or structure

of any kind or character, expect such as are specifically

authorized herein.

c. LAWS AND ORDINANCES. In the exercise of any privilege

granted by this license, licensee shall comply with all applicable

federal, state, local government, and municipal laws, statutes,

ordinances, rules, regulations, codes, decrees, orders and other

such requirements (collectively, Laws) including without

limitation Laws regarding wages and hours, health, safety,

building codes, emergencies, and security. Licensee shall

apply, pay for, and obtain all required licenses and permits,

including without limitation licenses and permits for fire and life

safety requirements.

d. SANITARY CONDITIONS. If this license gives possession

of United States property, the license shall at all times keep

the premises in a sanitary condition satisfactory to GSA.

e. DAMAGE. Except as may be otherwise provided by the

Special Conditions above, no United States property shall be

destroyed, displaced or damaged by the licensee in the

exercise of the privilege granted by this license without the

prior written consent of GSA and the express agreement of

the license promptly to replace, return, repair and restore any

such property to a condition satisfactory to GSA upon

demand.

f. INDEMNIFICATION. The licensee shall indemnify and save

harmless the United States, its agents, and employees against

any and all loss, damage, claim, or liability whatsoever, due to

personal injury or death, or damage to property of others

directly or indirectly due to the exercise by the licensee of the

privilege granted by this license, or any other act or omission

of license, including failure to comply with the obligations of

said license.

g. STORAGE. Any United States property which must be

removed to permit exercise of the privilege granted by this

license shall be stored, relocated or removed from the site,

and returned to its original location upon termination of this

license, at the sole cost and expense of the licensee, as

directed by GSA.

h. OPERATION. The licensee shall confine activities on the

property strictly to those necessary for the enjoyment of the

privilege hereby licensed, and shall refrain from marring or

impairing the appearance of said property, obstructing access

thereto, interfering with the transaction of Government

business and the convenience of the public, or jeopardizing the

safety of persons or property, or causing justifiable public

criticism.

i. NOTICE. Any property of the license installed or located

on the property affected by he license shall be removed upon

30 days' written notice from GSA.

j. G UARANTE E DEPOSI T . Any deposit which may be

requ i red t o gu a rant e e co m plia n ce w i th t h e te r ms a n d

conditions of this license shall be in the form of a certified

check, cashier's check or postal money order in the amount

designated above, payable to GSA.

k. BOND. Any bond required by this license shall be in the

amount designated above, executed in manner and form and

with sureties satisfactory to GSA.

l. EXPENSE. Any cost, expense or liability connected with or

in any manner incident to the granting , exercise, enjoyment or

relinquishment of this license shall be assumed and discharged

by the licensee.

m. FUTURE REQUIREMENTS. The licensee shall promptly

comply with such further conditions and requirements as GSA

may hereafter prescribed.

n. ATTEMPTED VARIATIONS. There shall be no variation or

departure from the terms of this license without prior written

consent of GSA.

o. NONDISCRIMINATION. The licensee agrees that no person

will be discriminated against in connection with the use made

by the licensee of the property on the ground of race, color or

national origin, nor will any person be denied the benefits of or

be subjected to discrimination under any program or activity

held, conducted or sponsored by the licensee in that any

activity, program or use made of the property by the licensee

will be in compliance with the provisions of Title VI of the Civil

Rights Act of 1964 (78 Stat. 238, 252; 42 U.S.C. 2000d)

and the applicable regulations of GSA (41 CFR Subpart

101-6.2).

The licensee will obtain from each person or firm, who

through contractual or other arrangements with the licensee,

provides services, benefits or performs work on the property,

a written agreement whereby the person or firm agrees to

assume the same obligations with respect to nondiscrimination

as those imposed upon the licensee by law and will furnish a

copy of such agreement to the licensor.

T h e b r e a c h b y t h e l i c e n s e e o f c o n d i t i o n s r e l a t i n g t o

nond i scri m inat i on s h all c onst i tute suff i cien t cau s e fo r

cancellations revocation of the license.

GSA FORM 1582 (REV. 10/2013) BACK