DGS Lease Action Request Form
Contact Information
Name
*
First Name
Last Name
E-mail
Department
Please Select
Office of the Governor
Administration
Law
Revenue
Education & Early Development
Alaska Commission on Postsecondary Education
Health & Social Services
Labor
Commerce, Community & Economic Development
Military & Veterans Affairs
Natural Resources
Fish & Game
Public Safety
Environmental Conservation
Corrections
Transportation & Public Facilities
Legislative Affairs & Finance
Alaska Court System
Division(s)
*
Location? (City/Town)
*
Is this lease action affecting an existing lease?
*
Yes
No
If you selected Yes, please specify the lease number. Otherwise, input "N/A"
*
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Which action from the list below would you like to take?
*
Add Space to Lease
New Lease or Extension
Holdover Lease
Renew Lease As-Is
Renew Lease with Alterations
Terminate Lease Agreement
Vacate Space within Lease
New Lease or Extension
Type of Space(s) required:
Ground/Land
Indoor Storage
Lab
Office
Other/Multiple
Outdoor Storage
Parking
Warehouse
Are you going to be leaving existing leased space?
*
Yes
No
Existing Lease move-out date (est.):
*
Projected move-in date (est.):
Old Term:
*
New Term:
*
Would you like this lease agreement to contain additional renewal options?
Yes
No
If yes, how many?
Projected budget for term of request (est.):
*
Number of budgeted PCNs that will be in this lease:
*
Mission Critical Requirements:
Additional Information
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
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Renew Lease Agreement As-Is
Does this lease have renewal options?
Yes
No
I don't know
Have your needs for this lease changed?
Yes
No
If your needs have changed, please specify which needs and how they have changed:
Projected budget for term of request (est.):
*
Number of budgeted PCNs currently in this lease:
*
Are there any outstanding issues that SSOA should be aware of at this time?
*
Additional Information:
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
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Renew Space with Alterations
Does this lease have renewal options?
Yes
No
I don't know
Have your needs for this lease changed?
Yes
No
How have your needs changed? Please specify:
Projected budget for term of request (est.):
*
Number of budgeted PCNs currently in this lease:
*
Are there any outstanding repairs, renovations, or lease compliance issues that SSOA should be aware of?
Additional Information:
Example: Floor plans, pictures, etc.
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
Save
Submit
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Terminate Lease Agreement
Please confirm that you intend to terminate your agency's lease entirely and vacate space:
*
Yes
No
Does this lease have renewal options remaining?
Yes
No
I don't know
Estimated termination date:
*
Will this termination effect any other leased space: (e.g. Are PCN transferring to any other leased space?)
Yes
No
Which lease or location are the PCNs transferring to?
*
If Yes, please specify which lease(s) and how they will be affected:
Additional Information
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
Save
Submit
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Add Space to Lease
Type of Space(s) required:
Office
Warehouse
Indoor storage
Outdoor storage
Parking
Yard
Dock
Multiple
Estimated square footage of addition:
Projected budget for term of this request (est.):
*
Estimated date of addition:
Is this additional space temporary?
Yes
No
If you selected Yes, please specify anticipated end date:
Estimated square footage of temporary addition:
Will this addition of space affect any other leased space: (Example: Are PCNs transferring from any other leased space?)
Yes
No
If Yes, please specify which lease(s) and how they will be affected:
Which lease or location are the PCNs transferring to?
*
Additional Information
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
Save
Submit
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Vacate Space Within Lease
Please provide the Lease or facility Occupancy Agreement number:
*
Estimated square footage to be vacated:
*
Estimated date to be vacated:
*
Is this abatement of space temporary?
Yes
No
If you selected Yes, please specify how long this abatement will last:
Will this abatement of space affect any other leased space: (e.g. Are PCNs transferring to any other leased space?)
Yes
No
If Yes, please specify which lease(s) and how they will be affected.
Which lease or location are the PCNs transferring to?
*
Additional Information
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
Save
Submit
Clear Form
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I would like to put this lease in Holdover
Yes
No
Please select a date range below.
Date
-
Month
-
Day
Year
Start Date
Date
-
Month
-
Day
Year
End Date
Does this lease have renewal options remaining?
Yes
No
I don't know
Additional Information
If there are any additional documents as part of this request, please attach them here:
Upload File(s)
Cancel
of
I certify that the facts herein and on supporting documents are correct, that this request constitutes a legal charge against funds and appropriations cited, that sufficient funds are encumbered to pay this obligation, or that there is a sufficient unencumbered balance in the appropriation cited to cover this obligation. I am aware that certifying false, inaccurate or misleading documents constitutes an unsworn falsification under AS 11.56.210
*
Yes
No
Save
Submit
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