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
EMAIL
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
or
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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