Records Managers

Certification Statement in Lieu of Checklist


Certification Statement in Lieu of Checklist

CERTIFICATION OF 36 CFR 1228, SUBPART K FACILITY COMPLIANCE

In accordance with 36 CFR 1228.240(e) I hereby certify that the facility located at (address) ______________________________________________________ and operated by (name of commercial vendor) __________________________ will be used to store (quantity) ______________ cubic feet of Federal records for (name of agency) ______________________________________ and has been inspected by (name of person inspecting facility for compliance) ___________________________________________________ for compliance with all of the requirements of 36 CFR 1228, subpart K. The facility has been found to meet all of the standards in subpart K except as noted below (with authorized National Archives and Records Administration waiver - see attached approved waiver). I am also attaching information as required by 36 CFR 1228.242(a) to demonstrate compliance for the facility fire protection systems.

NARA APPROVED WAIVERS:

(please list all waivers granted by NARA for this facility and attach a copy of the waiver)

Signed

__________________________________
Records Management Officer (or authorized Representative)

Please forward this certification to: Director, Space and Security Management Division, NAS, 8601 Adelphi Road, College, Park, MD 20740-6001

Note: This certification will have to be renewed every ten (10) years or when there are changes made to the facility that would impact the certification of the facility.

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The U.S. National Archives and Records Administration
1-86-NARA-NARA or 1-866-272-6272

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