Fill - Free fillable Vehicle Lease Attachment Instructions (US House of Representatives) PDF form

Vehicle Lease Attachment – Instructions

(District is LESSEE)

The Vehicle Lease Attachment (“Attachment”) is a four-page document that must accompany each

vehicle lease that the Member/Member-Elect signs and wants to be paid from the MRA.

 Page 1 requires the Member/ Member-Elect’s District number and state to be written in Section 1.

 Page 4 requires the signature of both the car dealer/leasing company and the Member. The box in

the middle of Page 4 requests contact information for the person in the Member’s office whom

we should call if there are any problems or questions (the scheduler, etc.).

 Prior to either party signing a lease, the Member/ Member-Elect must submit the proposed

lease, accompanied by a copy of the Attachment, to the Administrative Counsel for review

and approval. If the proposed terms and conditions of the lease are determined to be in

compliance with applicable law and House Rules and Regulations, the Administrative Counsel

will notify the Member/Member-Elect that (s)he may proceed with the signing of the lease.

Please submit the proposed lease and Attachment either by e-mail in PDF form

(leases@mail.house.gov) or fax (202-225-6999).

 Once signed by both parties, the lease and the Attachment must be submitted to the

Administrative Counsel for final approval. They may be sent by email in PDF form or faxed to

202-225-6999. If approved, Administrative Counsel will send them to Finance so that payment

can begin. If there are errors, you will be contacted and required to correct them before the lease

is approved.

 When entering into a lease in the District’s name, there is an additional document entitled

“Statement of Authority” — a letter from the Committee on House Administration — which must

be provided to the car dealer/ leasing company (with a copy to Administrative Counsel). You just

need to fill out the State and District Number of the Member/Member-Elect on this document.

 If the lease extends beyond the length of the congressional term (i.e., past January 2, 2019), then

the Member must also submit the “Member Statement Acknowledging Personal Responsibility

for Vehicle Lease,” which can be found on www.house.gov under “Vehicle Lease Forms.”

 Any fees, charges or penalties for termination, cancellation, traffic violations, depreciation loss

based on premature return and the like are not reimbursable from the Member’s MRA.

Note: If the Lessee is the Member, use the “Vehicle Lease Attachment-Member is Lessee” form.

NO LEASE OR ATTACHMENT CAN BE SIGNED BEFORE THEY HAVE BEEN

APPROVED BY THE ADMINISTRATIVE COUNSEL.

For new Members, the term for a vehicle lease for the 115th

Congress may not commence prior

to January 3, 2017.

Payments in excess of $1,000 per month cannot be charged against a Member’s

Representational Allowance (“MRA”). This limit does not apply to mobile offices.

For payments to be made from a MRA, a leased vehicle must be selected from the list of vehicles

designated by the Environmental Protection Agency as “low greenhouse gas emitting vehicles.”

To find out which vehicles qualify, visit epa.gov/otaq/climate/regs-fleets.htm and review the links

under “Search for Low GHG-Emitting Vehicles.”

U.S. House of Representatives

Washington, D.C. 20515

Vehicle Lease Attachment (District is Lessee)

(Page 1 of 4 – 115th

Congress)

1. Incorporated Vehicle Lease Attachment. Lessor (Car Dealer/Leasing Company) and Lessee

( Congressional District of , U.S. House of

Representatives) agree that this Vehicle Lease Attachment (“Attachment”) is incorporated into

and made part of the Vehicle Lease (“Lease”) to which it is attached.

2. Authorization. For purposes of this Attachment, the Lease, and all documents associated with

the Lease, the Member elected to represent the Congressional District designated as the Lessee

(“Member”) is authorized to sign on behalf of Lessee.

3. Performance. Lessor expressly acknowledges that neither the U. S. House of Representatives

(the “House”) nor its Officers are liable for the performance of the Lease. Lessor further

expressly acknowledges that payments made by the Chief Administrative Officer of the House

(the “CAO”) to Lessor to satisfy Lessee’s rent obligations under the Lease — which payments are

made solely on behalf of the Member in support of his/her official and representational duties as a

Member of the House — shall create no legal obligation or liability on the part of the CAO or the

House whatsoever. The Member shall be solely responsible for the performance of the Lease and

Lessor expressly agrees to look solely to the Member for such performance.

4. Modifications. Any amendment to the Lease must be in writing. Lessor and Lessee also

understand and acknowledge that the Administrative Counsel for the CAO (“Administrative

Counsel”) must review and give approval of any amendment to the Lease prior to execution.

5. Compliance with House Rules and Regulations. Lessor and Lessee understand and

acknowledge that the Lease shall not be valid, and the CAO will not authorize the disbursement

of funds to the Lessor, until the Administrative Counsel has reviewed the Lease to determine that

it complies with applicable federal law including but not limited to P.L. 110-140, with the Rules

of the House and the Regulations of the Committee on House Administration, and has approved

the Lease by signing on page 4 of this Attachment.

6. Payments. The Lease is a fixed term lease with monthly installment payments for which

payment is due in arrears on or before the end of each calendar month. In the event of a payment

dispute, Lessor agrees to contact the Office of Finance of the House at 202-225-7474 to attempt

to resolve the dispute before contacting Lessee.

7. Void Provisions and Additional Charges. Any provision in the Lease purporting to require the

payment of a security deposit shall have no force or effect. Furthermore, any provision in the

Lease purporting to vary the dollar amount of the rent specified in the Lease by any cost of living

clause, operating expense clause, pro rata expense clause, escalation clause, or any other

adjustment or measure — other than an adjustment for excess mileage, vehicle wear and tear,

registration fees, applicable personal property taxes or applicable use taxes — during the term of

the Lease shall have no force or effect. Likewise, any provision in the Lease allowing for any

disposition fee, expiration fee, installment sale, lease-to-purchase, lease with option to purchase,

or similar arrangement shall have no force or effect, and Lessee or the Member shall acquire no

equity or other interest in the vehicle title under the Lease. Any fees, charges or penalties for

This version is to be used if the vehicle is leased to the District – not to the Member.

Vehicle Lease Attachment (District is Lessee)

(Page 2 of 4 – 115th

Congress)

termination, cancellation, traffic violations, depreciation loss based on premature return, and the

like, shall be the direct responsibility of the Member and shall not be paid by the CAO on behalf

of the Lessee.

8. Option if Lease Exceeds Member’s Constitutional Term. In the event the term of the Lease

exceeds the constitutional term of the Congress to which the Member was elected (or reelected)

and, during such Lease term, the Member is not reelected (either because (s)he resigns, retires, is

defeated, does not seek reelection, or for any other reason other than death), Lessor agrees that

the Member may, at his or her sole option, either: (a) assume all obligations of the Lease as a

substitute for the Lessee, provided the Member is otherwise qualified and pays any applicable

fees; or (b) terminate the Lease without charge or penalty by giving thirty (30) days’ prior written

notice to Lessor. The commencement date of such thirty (30) day termination notice shall be the

date such notice is delivered or, if mailed, the date on which such notice is postmarked. In the

event the Member does not exercise either option specified in this Section 8, the Lease shall

terminate, without charge or penalty to the Lessee, on the last day of the calendar month which

follows the month in which the Member leaves office.

9. Death, Resignation or Removal. In the event the Member dies, resigns or is removed from

office during the term of the Lease, the Clerk of the House may, at his or her sole option,

terminate the Lease without charge or penalty by giving thirty (30) days’ prior written notice to

Lessor. The commencement date of such thirty (30) day termination notice shall be the date such

notice is delivered or, if mailed, the date on which such notice is postmarked.

10. Early Termination. If either Lessor or Lessee terminates the Lease pursuant to the terms of the

Lease, the terminating party agrees to promptly file a copy of any termination notice with the

Office of Finance, U.S. House of Representatives, O’Neill Federal Building, Suite 3220, Attn:

Levi Matthews, Washington, D.C. 20515, and with the Administrative Counsel, Office of the

Chief Administrative Officer, U.S. House of Representatives, 217 Ford House Office Building,

Washington, D.C. 20515.

11. Statutory Changes. If, after the initial lease date contained in the fully executed and approved

Lease, the Congress enacts a statute or the House adopts a regulation restricting the availability of

Member’s Representational Allowance reimbursement to a dollar level below the recurring

monthly lease payment for this vehicle, then Lessee may elect in writing (after review by

Administrative Counsel), within thirty (30) days of such statute or regulation becoming effective,

to terminate this Lease without incurring any early termination liability set forth in the Lease;

provided, however, that Lessee must remit to Lessor any past due and unpaid payments, fees, and

charges due under the Lease and Lessee shall remain liable for any: (a) excess wear and use

charges (based on a pro rata basis for mileage); (b) fees, charges, or penalties for traffic

violations, and (c) allowable taxes incurred during the period of Lessee’s possession of the

vehicle. Upon Lessee’s election to terminate the Lease pursuant to this Section 11, Lessee shall

deliver the vehicle to Lessor pursuant to Lessor’s instructions.

12. Notification upon Occurrence of Certain Events. Lessor agrees to promptly notify Lessee in

writing in the event Lessor sells, transfers or otherwise disposes of its business; in the event

Lessor is placed in bankruptcy proceedings (whether voluntarily or involuntarily); in the event the

Lessor’s business is foreclosed upon; or in the event of any similar occurrence. Lessee shall

promptly file a copy of any such notice with the Office of Finance, U.S. House of

Representatives, O’Neill Federal Building, Suite 3220, Attn: Levi Matthews, Washington, D.C.

20515.

Vehicle Lease Attachment (District is Lessee)

(Page 3 of 4 – 115th

Congress)

13. Limitation of Liability. Lessor agrees that neither Lessee nor the House nor any of the House’s

officers or employees will indemnify or hold harmless Lessor against any liability of Lessor to

any third party that may arise during or as a result of the Lease.

14. Electronic Funds Transfer. Lessor agrees to accept monthly lease payments by Electronic

Funds Transfer and agrees to provide the Office of Finance, U.S. House of Representatives, with

all banking information necessary to facilitate such payments. Lessee understands and

acknowledges that for payments under this Attachment to be reimbursed from the Member’s

Representational Allowance the leased vehicle must meet the EPA criteria for Low Greenhouse

Gas Emitting Vehicles, contained in P.L. 110-140.

15. Refunds. Lessor shall promptly refund to the CAO, without formal demand, any payment made

to the Lessor by the CAO for any period for which rent is not owed because the Lease has ended

or been terminated.

16. Conflict. Should any provision of this Attachment be inconsistent with any provision of the

attached Lease (or with any subsequent or additional amendments thereto), the provisions of this

Attachment shall control, and those inconsistent provisions of the Lease (or any subsequent or

additional amendments thereto) shall have no force and effect to the extent of such inconsistency.

17. Construction. Unless the clear meaning requires otherwise, words of feminine, masculine or

neuter gender include all other genders and, wherever appropriate, words in the singular include

the plural and vice versa.

18. Fair Market Value. The Lease is entered into at fair market value as the result of a bona fide,

arms-length, marketplace transaction. The Lessor and Lessee certify that the parties are not

relatives nor have had, or continue to have, a professional or legal relationship.

19. Counterparts. This Lease may be executed in any number of counterparts and by facsimile

copy, each of which shall be deemed to be an original but all of which together shall be deemed

to be one and the same instrument.

20. Section Headings. The section headings of this Lease are for convenience of reference only and

shall not be deemed to limit or affect any of the provisions hereof.

[Signature page follows.]

U.S. House of Representatives

Washington, D.C. 20515

Vehicle Lease Attachment (District is Lessee)

(Page 4 of 4 – 115th

Congress)

IN WITNESS WHEREOF, the parties have duly executed this Vehicle Lease Attachment (District is

Lessee) as of the later date written below by the Lessor or the Lessee.

U.S.H.R. District of

Print Name (Lessor / Dealer) (Lessee)

By:

Lessor Signature Print Name (Member/Member-Elect’s Name)

By:

Member/Member-Elect’s Signature

Date Date

This Attachment and the attached Lease have been reviewed and are approved, pursuant to the Regulations

of the Committee on House Administration:

Signed

(Administrative Counsel)

Date , 20 .

From the Member’s Office, who should be contacted with questions?

Name: Phone: ( ) E-mail: @mail.house.gov

Send completed forms to: Administrative Counsel, 217 Ford House Office Building, Washington, D.C. 20515.

Copies may also be faxed to 202-225-6999

Congress of the United States

House of Representatives

COMMITTEE ON HOUSE ADMINISTRATION

1309 Longworth House Office Building

Washington, D.C. 20515-6157

(202) 225-2061

www.house.gov/cha

Statement of Authority

Dear Sir or Madam:

The Committee on House Administration of the U.S. House of Representatives (the “House”) has

authorized each Member of the House to enter into a long-term vehicle lease in the name of the

congressional district that the Member represents. The lessee in this lease shall be listed as “

Congressional District of , U.S. House of Representatives.” Such a

State

leased vehicle is to be used, consistent with applicable law, House Rules and the Regulations of the

Committee on House Administration, to support the conduct of the Member’s official and

representational duties on behalf of the congressional district he/she represents in the U.S. Congress. The

House’s “Vehicle Lease Attachment–District is Lessee” form must be attached to and made part of the

lease.

Upon approval of the lease by the Administrative Counsel to the Chief Administrative Officer of

the House, payment of the monthly installments due to the lessor under the terms of the lease will be

made from the Member’s Representational Allowance by the Chief Administrative Officer of the House.

Payment will be made in arrears on or before the end of the calendar month.

The Committee on House Administration recognizes the need to purchase liability and other

required insurance for a leased vehicle and reiterates that each Member is authorized to use his/her

Member’s Representational Allowance to purchase such insurance.

The term of the lease may not exceed the constitutional term of the Congress to which the

Member has been elected unless the Member acknowledges in writing his/her personal responsibility to

fulfill any outstanding obligation in the event the Member ceases to serve in Congress. If, in this

circumstance, the Member does not financially qualify for the transfer of the lease to the Member

personally, the Member must terminate the lease at his/her personal expense.

If you have any questions, please contact the Administrative Counsel at 202-225-6969.

Member/Member-Elect Statement

Acknowledging Personal Responsibility for Vehicle Lease

Dear Mr. Chairman:

Because this vehicle lease (“Lease”) exceeds the constitutional term of the Congress for which I am elected, I agree

to assume all liability for any payments and debts that may arise if I am no longer a Member of Congress. These

costs include, but are not limited to, monthly payments, termination fees, and/or transfer fees.

Additionally, I agree to indemnify the U.S. House of Representatives (the “House”) for any charges assessed

against the House or its officers under the Lease.

Description of vehicle (Make/Model):

Lease end date: , 20

Print Name (Lessee/Member/Member-Elect of Congress)

Lessee Signature

, 20 (Date)

This page is to be signed only by the Member/Member-Elect and is to be

submitted to Administrative Counsel along with the Vehicle Lease Attachment.

U.S. House of Representatives

Substitute W-9 and ACH Vendor/Miscellaneous Payment Enrollment Form

INSTRUCTIONS

FAX NUMBER:

(202) 225-6914

SECTION I UNITED STATES HOUSE OF REPRESENTATIVES INFORMATION

ADDRESS US HOUSE OF REPRESENTATIVES - ACCOUNTING, 3110 O'NEILL FEDERAL BUILDING, WASHINGTON DC 20515

AGENCY IDENTIFIER

53-6002523

AGENCY LOCATION CODE 4832 TELEPHONE NUMBER (202) 226-2277

SECTION II PAYEE/COMPANY INFORMATION

BUSINESS NAME/DISREGARDED ENTITY NAME OR DBA, IF DIFFERENT THAN NAME

ON YOUR INCOME TAX RETURN

ADDRESS/CITY/STATE/ZIP Enter the correct Tax Identification Number type

SOCIAL SECURITY NUMBER (SSN) EMPLOYER TAX ID NUMBER (EIN)

CONTACT PERSON NAME PURCHASE ORDER ADDRESS/CITY/STATE/ZIP

PO EMAIL

TELEPHONE NUMBER FAX NUMBER TELEPHONE NUMBER FAX NUMBER

REMIT TO ADDRESS

CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION (required)

Partnership

Trust/Estate

C Corporation

SECTION III FINANCIAL INSTITUTION INFORMATION

BANK NAME TELEPHONE NUMBER

NINE-DIGIT ROUTING TRANSIT NUMBER

___ ___ ___ ___ ___ ___ ___ ___ ___

DEPOSITOR ACCOUNT TITLE

DEPOSITOR ACCOUNT NUMBER

LOCKBOX NUMBER

TYPE OF ACCOUNT CHECKING SAVINGS LOCKBOX

SECTION IV

SOCIO-ECONOMIC INFORMATION

Type of Business Large Business-No Socio-Economic Designations Minority SmBusiness Sm-Disadv/Minority Sm-Disadv Only SmMin Only

Sm-Disadvantaged Business Prog 8 (a) Firm HUBZone Program HUBZone Eligible

Emerging Small Business

Women-Owned Business

Other Preference Programs Buy Indian Directed to JWOD Non-Profit No Preference/Not Listed Small Business Set-Aside Very Small Business Set-Aside

Veteran Owned Status Non-Vet Owned SmBus Other Vet Owned SmBus Serv-Disabled Vet Other Bus Serv-Disabled Vet Owned SB Vet-Owned Other Bus

Size of Business: (A) 50 or less (B) 51-100 (C) 101-250 (D) 251-500 (E) 501-750 (F) 751-1,000 (G) Over 1,000 (M) 1 million or less

(N) 1.1-2 million (P) 2.1-3.5 million (R) 3.1-5 million (S) 5.1-10 million (T)10.1-17 million (Z)Over 17 million

SECTION V

CERTIFICATION OF DATA BY PAYEE/COMPANY

NAME TITLE/POSITION

SIGNATURE

DATE

TELE

Internal Revenue Code 6109, 31 U.S.C. 3322, 31 CFR 210 and the 1996 Debt Collection Improvement Act require all entities that do business with the United

States Government to provide a Tax Identification Number (TIN) and Electronic Funds Transfer (EFT) information for payment. PL 93-579 protects your privacy

and mandates that the information never be published or used for any other purpose than to pay you. Please complete all sections below, sign and return via the

email or fax number listed.

NAME AS SHOWN ON YOUR INCOME TAX RETURN

RETURN FORM TO:

Exemptions (codes apply only to certain

entities, not individuals):

Exempt payee code (if

any)

Exemption from FATCA reporting code

(if any)

(Applies to accounts maintained outside

the U.S.)

U.S.)

S Corporation

Individual/Sole Proprietor or

Single Member LLC

Limited Liability Company. Check the tax classification: C corporation S corporation Partnership

Note. F or a

single-member LLC

that is disregarded, check the appropriate box for the tax classification of t he single-member owner.

Government Entity. Check the tax classification:

Federal State Local

Other

This form must be completed using Adobe Reader.

vendorEFT@mail.house.gov

USHR v. 2015.3b ms

Instructions for Completing

U.S. House of Representatives

Substitute W-9 and ACH Vendor/Miscellaneous Payment Enrollment Form

Section I - Agency Information – Includes the name and address, agency identifier, agency location code and

telephone number for the House of Representatives.

Section II - Payee/Company Information – Print or type the name of the payee/company and address that will

receive payment, social security or taxpayer ID number, contact person name, telephone number and email of the

payee/company. Print or type the purchase order and remit to addresses if different from the payee/company

address. Check the appropriate boxes for federal tax classification.

Section III - Financial Institution Information – Print or type the name and address of the payee/company’s

financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit

routing transit number, depositor (payee/company) account title and account number. Check the appropriate box

for type of account. Payee/Company may include a voided check with this form.

ACH Account Information Located on a Check or Deposit Ticket

FINANCIAL INSTITUTION NAME name of the financial institution to which the payments are to be directed

ROUTING TRANSIT NUMBER (RTN) financial institution's 9 digit routing transit number;

found on the bottom of a check or deposit ticket or from your Financial Institution

ACCOUNT TITLE employee's or vendor's name on the account

ACCOUNT NUMBER account number at the financial institution

Section IV - Socio-Economic Information – Check the boxes for each category, if applicable: type of business,

small disadvantaged business program, HUBZone program, emerging small business, women-owned business,

other preference programs, Veteran owned status and size of business. Detailed information related to Small

Business programs can be found at http://www.sba.gov/.

Section V - Certification of Data By Payee/Company – Print or type the name, title/position and phone number of

the Authorized official. The Authorized official must sign and date the form.

1. Routing Transit Number (RTN)

– nine digits located between

two symbols. This number

identifies the bank holding your

account and check processing

center.

2. Account number – this is your

complete account number.

Your account number can be

up to 17 digits. Please include

leading zeros.

3. ACH Routing Transit Number –

Automated Clearing House

routing number, use this

number for your Routing

Transit Number (RTN) if you

bank with SunTrust Bank.

4. Check number – This

information is not necessary -

do not provide

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