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USA Patriot Act Certification Lease Exhibit

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CERTIFICATION RELATED TO THE USA PATRIOT ACT LEASE EXHIBIT

EXHIBIT [INSERT APPLICABLE LETTER]

CERTIFICATION RELATED TO THE USA PATRIOT ACT

The undersigned (“Tenant”) hereby certifies to ____________________ (“Landlord”) the following:

1. Tenant maintains a place of business that is located at a fixed address (other than an electronic address or post office box) known as __________________________.

2. Tenant has no knowledge that it is not in full compliance with laws relating to bribery, corruption, fraud, money laundering and the Foreign Corrupt Practices Act.

3. The names and addresses of Tenant's Owners (defined hereinafter), officers and directors are accurately reflected on Annex A to this certification. “ Owner ” means any individual who owns, controls, or has the power to vote more than 5% of any class of Tenant's stock, or otherwise controls or has the power to control Tenant.

4. None of said owners, officers or directors appears on any of the following lists maintained by the United States government (“ Government Lists ”):

(a) The two lists maintained by the United States Department of Commerce (Denied Persons and Entities; the Denied Persons list can be found at www.bxa.doc.gov/DPL/Default.shtm; the Entity List can be found at www.bxa.doc.gov/Entities/Default.htm;

(b) The list maintained by the United States Department of Treasury (Specially Designated Nationals and Blocked Persons, which can be found at www.ustreas.gov/ofac/t11sdn.pdf);

(c) Two lists maintained by the United States Department of State (Terrorist Organizations and Debarred Parties; the State Department List of Terrorists can be found at www.state.gov/s/ct/rls/fs/2001/6531.htm; the List of Debarred Parties can be found at www.pmdtc.org/debar059.htm); and

(d) Any other list of terrorists, terrorist organizations or narcotics traffickers maintained pursuant to any of the rules and regulations of Office of Foreign Assets Control, U.S. Department of the Treasury, or by any other government.

5. Tenant does not transact business on behalf of, or for the direct or indirect benefit of, any individual or entity named on any Government List.

I, _____________________, certify that I have read and understand this Certification and that the statements made in this certification and the attached Annexes are true and correct.

TENANT:

______________________________

By:

Title:

Executed on this _____ day of ___________, 20__.

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ANNEX “A”

TENANT’S OWNERS

 

 

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