Form SF 123 SF 123 Transfer Order-Surplus Personal Property

TRANSFER ORDER
SURPLUS PERSONAL PROPERTY

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1. ORDER NUMBER(S)
a.
b.

PAGE
OF

PAGES

OMB Control Number: 3090-0014
Expiration Date: XX/XX/20XX

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork
Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The
OMB control number for this collection is 3090-0014. We estimate that it will take 8 minutes to read the instructions, gather the facts, and answer the questions.
Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S.
General Services Administration, Regulatory Secretariat Division (MVCB), 1800 F Street, NW, Washington, DC 20405.
3. SURPLUS
RELEASE DATE

2. TYPE OF ORDER
STATE AGENCY
7. TO

DOD (SEA)

5.

4. SET ASIDE DATE

FAA

GSA (GENERAL SERVICES ADMINISTRATION)*

6. TOTAL ACQUISITION COST
NONREPORTABLE

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REPORTABLE
8. LOCATION OF PROPERTY

9. HOLDING AGENCY (Name and address)*

10. FOR GSA USE ONLY
SOURCE CODE
STATE

CITY
TYPE OF DONATION
ADJUSTED ALLOCATION CODE

11. PICKUP OR SHIPPING INSTRUCTIONS*

LINE/
ITEM
NUMBER
(a)

12. SURPLUS PROPERTY LIST

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IDENTIFICATION
NUMBER(S)

DESCRIPTION

(b)

(c)

DEMILITARZATION CONDITION QUANTITY
AND UNIT
CODE
CODE
(d)

(e)

ACQUISITION COST
UNIT

TOTAL

(g)

(h)

(f)

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13. TRANSFEREE ACTION
Transferee certifies and agrees
that transfers and donations are
made in accordance with the
Code of Federal Regulations at
41 CFR 101-44, and to do the
terms, conditions, and
assurances as specified on this
document.

a. TRANSFEREE
(Name and address of State Agency, SEA, or
public airport)*

a. DETERMINING OFFICER - DEPARTMENT OF
DEFENSE (DOD) OR FEDERAL AVIATION
I certify that the administrative
ADMINISTRATION (FAA)*
actions pertinent to this order are
in accordance with 41 CFR
d. GSA APPROVING OFFICER
101-44 and as specified on this
document have been and are
being taken.
14. ADMINISTRATIVE ACTION

*Please include "ZIP codes" in all address blocks.
Previous Editions NOT usable

b. SIGNATURE AND TITLE OF STATE AGENCY OR
DONEE REPRESENTATIVE

c. DATE

d. SIGNATURE OF HEAD OF THE SERVICE
EDUCATIONAL ACTIVITY (SEA)
(School or National Headquarters)

e. DATE

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b. SIGNATURE OF DETERMINING OFFICER

c. DATE

e. SIGNATURE OF APPROVING OFFICER

f. DATE

STANDARD FORM 123 (REV. XX/20XX)
Prescribed by GSA FMR (41 CFR) 102-37

CERTIFICATIONS, AGREEMENTS, AND ASSURANCES

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The transferee specified in block 13a on the obverse of this transfer order, in consideration of and for the purpose of obtaining any or all
property for donation covered by such transfer order, recognizes and agrees that any such transfer will be made by the United States in
reliance on the following certifications, agreements, and assurances:
1. OFFICIAL SIGNING IN BLOCK 13b AS REPRESENTATIVE OF:
a. STATE AGENCY.
(1) As a condition of the allocation of property listed in block 12, the State agency, for itself, and with respect to any such property to be distributed in an
adjacent State, pursuant to an approved Interstate Distribution Agreement as agent for an authorized representative of the adjacent State, hereby
certifies:
(a) It is the agency of the State designated under State law and as such has legal authority within the meaning of section 203(j) of the Federal Property
and Administrative Services Act of 1949, 63 Stat. 386, as amended (hereinafter referred to as the Act), and the regulations of the General Services
Administration to receive surplus property for distribution within the State to eligible donees within the meaning of the Act and regulations.
(b) The property listed on this document or attachments hereto is usable and needed by a public agency for one or more public purposes, such as
conservation, economic development, education, parks and recreation, public health, public safety, and programs for older individuals, by an
eligible nonprofit organization or institution which is exempt from taxation in the State under section 501 of the Internal Revenue Code of 1954 for
the purpose of education or public health (including research for any such purpose), or by an eligible nonprofit tax-exempt activity for programs for
older individuals, certain Veterans service organizations whose membership comprises substantially of veterans and are recognized by the
Department of Veterans Affairs pursuant to the United States Code at 38 U.S.C. 5902, or other donees authorized by law.
(c) When the property is picked up by or shipped to a State agency, the State certifies that it has available adequate funds, facilities, and personnel to
effect accountability, warehousing, proper maintenance, and distribution of the property.
(d) When the property is distributed by a State agency to a donee, or when delivery is made direct from a holding agency to a donee, that the donee
who is acquiring the property is eligible within the meaning of the Act and the regulations of the General Services Administration, ,and that such
property is needed by the donee and usable for their mission.
(e) As directed by Executive Order 14173, the State Agency and potential donees of this agreement must agree that its compliance in all respects with
all applicable Federal anti-discrimination laws is material to the government's payment decisions for purposes of section 3729(b)(4) of title 31,
United States Code; and does not operate any programs promoting Diversity, Equity, Inclusion (DEI) that violate any applicable Federal
anti-discrimination laws.

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(2) With respect to donable property picked up by or shipped to a State agency, the State agency agrees to the following:
(a) The right to possession only is granted and the State agrees to make prompt statewide distribution of the same, on a fair and equitable basis, to
donees eligible to acquire property under section 203(j) of the Act and regulations of the General Services Administration, after such eligible
donees have properly executed the appropriate certifications and agreements established by the State agency and/or the General Services
Administration.
(b) Title to such property shall remain in the United States of America although the State shall have taken possession thereof. Conditional title to the
property shall pass to the eligible donee when it executes the certifications and appropriate agreements required by the State agency and has
taken possession of the property.
(c) The State agency further agrees that it will pay promptly the cost of care, handling, and shipping incident to taking possession of such property and
that during the time the title remains in the United States of America, it will be responsible, as a bailee for mutual benefit, for such property from the
time it is released to the State agency or to the transportation agent designated by the State agency; and that in the event of any loss of or damage
to any or all of the property, it will file such claim and/or institute and prosecute to conclusion such proceedings as may be necessary to recover for
the account of the United States of America the fair value of any such property lost or damaged.
(d) No surplus property hereafter approved for transfer by the General Services Administration shall be retained by the State agency for use in
performing its functions unless such property use is authorized by the General Services Administration in accordance with the provisions of a
cooperative agreement entered into between the State agency and the General Services Administration.

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(3) Where an applicant State agency is acting under an interstate distribution agreement approved by the General Services Administration as an agent
and authorized representative of an adjacent State with which it shares a common boundary, the certifications and agreements required above shall
also be made by the applicant State agency respecting the donees in such adjacent State to which distribution will be made and the property to be
distributed in the adjacent State, and such certifications and agreements shall constitute the certifications and agreements to the adjacent State on
whose behalf and as whose authorized representative the applicant State agency is acting.

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b. SERVICE EDUCATIONAL ACTIVITY. Pursuant to section 203(j) of the Act and regulations promulgated thereunder, request is hereby made for the
property listed in block 12. The transferee agrees that:
(1) the signer is appropriately authorized;
(2) the property is needed by the donee and usable to carry out the educational purposes of the transferee, is required for use to fill an existing need, and
will be used for such purposes within 1 year after it is obtained; and
(3) funds are available and will be paid, when requested, to cover cost of care and handling incident to the donation, including packing preparation for
shipment, loading, and transporting such property.
c. PUBLIC AIRPORT. Pursuant to the Act and section 13(g) of the Surplus Property Act of 1944, 58 Stat. 770, as amended, and regulations promulgated
thereunder, request is hereby made for the property listed in block 12. The transferee agrees that
(1) funds are available to pay the costs of care and handling incident to donation, including packing, preparation for shipping, loading, and transporting
such property; and
(2) if such property is donated to the transferee it will
(a) not be used, sold, salvaged, or disposed of for other than airport purposes without the consent of the Federal Aviation Administration;
(b) be kept in good repair;
(c) be used for airport purposes;
(d) be appropriately marked as Federal surplus property and will be made available for inspection upon request; and
(e) at the option of the United States, revert to the United States in its then existing condition, if all the aforesaid conditions are not met, observed, or
compiled with.

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STANDARD FORM 123 (REV. XX/20XX) PAGE 2

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d. STATE AGENCY SERVICE EDUCATIONAL ACTIVITY, PUBLIC AIRPORT OR DONEE.
(1) Assurance of Compliance, with GSA regulations, under Title VI of the Civil Rights Act of 1964, section 606 of Title VI of the Federal Property and
Administrative Services Act of 1949, as amended, section 504 of the Rehabilitation Act of 1073, as amended, Title XI of the Education Amendments of
1972, as amended, and section 303 of the Age Discrimination Act of 1975. The transferee agrees that:
(a) the program, for or in connection with which any property covered by this transfer order is acquired by the transferee, will be conducted in
compliance with, and the transferee will comply with and will require any other person (any legal entity), who through contractual or other
arrangements with the transferee is authorized to provide services or benefits under said program, to comply with all requirements imposed by or
pursuant to the regulations of the General Services Administration (41 CFR 101-6.2 or 101.8) issued under the provisions of Title VI of the Civil
Rights Act of 1964, section 606 of Title VI of the Federal Property and Administrative Services Act of 1949, as amended, section 504 of the
Rehabilitation Act of 1973, and amended, 303 of the Age Discrimination Act of 1975 to the end that no person in the United States shall, on the
ground of race, color, national origin, sex, or age, or that no otherwise qualified disabled person shall solely by reason of the disability, be excluded
from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the transferee receives
Federal assistance from the General Services Administration;
(b) this agreement shall be subject in all respects to the provisions of said regulations;
(c) this agreement shall obligate the transferee and any other person (any legal entity), who authorized to provide services or benefits under said
program, for the period during which it retains ownership or possession of any such property;
(d) the transferee will promptly take, and continue to take, such action as may be necessary to effectuate this agreement;
(e) the United States shall have the right to seek judicial enforcement of this agreement; and
(f) this agreement shall be binding upon any successor in interest.

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(2) The transferee agrees that the Government assumes no liability for any damages to the property of the State or donee, any person, or public property,
or for the personal injuries, illness, disabilities or death to employees of the State or donee, any other person subject to their control or any other person
including members of the general public, arising from or incident to the property use, processing, disposition, or any subsequent operation performed
upon, exposure to or contact with any component, part, constituent or ingredient of this item, or substance, or material, and shall hold harmless and
indemnify the Government for any and all costs, judgment, action, debt, liability costs and attorney's fees or any other request for monies or any type
of relief arising from or incident to the transfer, donation, use processing, disposition, or any subsequent operation performed upon, exposure to or
contact with any component, part, constituent or ingredient of this item, material or substance, whether intentional or accidental.

STATEMENT OF ADMINISTRATIVE ACTIONS
2. OFFICIAL SIGNING IN BLOCK 14b AS REPRESENTATIVE OF:
a. DEPARTMENT OF DEFENSE. The Department of Defense (Defense Logistics Agency (DLA) or Sponsoring Military Service) has determined that the
personal property listed in block 12 is authorized and approved for donation to the SEA in block 13a (subject to any interim request by a Federal agency).
b. FEDERAL AVIATION ADMINISTRATION. The Administrator of the Federal Aviation Administration has determined that the surplus personal property
listed in block 12 is essential, suitable, or desirable for the development, improvement, operation, or maintenance of a public airport, or reasonably
necessary to fulfill the immediate and/or able future requirements of the grantee for the development, improvement, operation, or maintenance of a public
airport.

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3. OFFICIAL SIGNING IN BLOCK 14e AS REPRESENTATIVE OF:
GENERAL SERVICES ADMINISTRATION. The surplus personal property listed in block 12, except any disapproved items, is approved for transfer for
donation purposes. Property listed hereon requested for transfer by a State agency is hereby allocated to that State. Such property will be held by the
holding agency for a period not to exceed 42 calendar days from the surplus release date pending receipt of pickup or shipping instructions, whereupon it will
be released to the donee.

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STANDARD FORM 123 (REV. XX/20XX) PAGE 3