Form SF-123 Transfer Order-Surplus Personal Property

1. ORDER NUMBER(S)

PAGE

TRANSFER ORDER
a.
SURPLUS PERSONAL PROPERTY b.

OF

PAGES

OMB Control Number: 3090-0014
Expiration Date: 1/31/2019

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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.
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Washington, DC 20405.
2. TYPE OF ORDER

3. SURPLUS
RELEASE DATE

STATE AGENCY

DOD(SEA)

4. SET ASIDE DATE

NONREPORTABLE
REPORTABLE

FAA

GENERAL SERVICES ADMINISTRATION*

7. TO

5.

6. TOTAL ACQUISITION COST

8. LOCATION TO 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*

12. SURPLUS PROPERTY LIST
L/I
NO.

IDENTIFICATION
NUMBER(S)

DESCRIPTION

DEMIL.
CODE

(a)

(b)

(c)

(d)

13. TRANSFEREE ACTION

(e)

(f)

UNIT

TOTAL

(g)

(h)

a. TRANSFEREE (Name and address of State Agency, b. SIGNATURE AND TITLE OF STATE AGENCY OR
DONEE REPRESENTATIVE
SEA, or public airport)*

Transferee certifies and agrees
that transfers and donations are
made in accordance with 41 CFR
101-44, and to do the terms,
conditions, and assurances as
specified on this document.
14. ADMINISTRATIVE ACTION

ACQUISITION COST

COND. QUANTITY
CODE AND UNIT

a. DETERMINING OFFICER (DOD OR FAA)*

I certify that the administrative
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.
*Please include "ZIP codes" in all address blocks.
Previous Editions NOT usable

c. DATE

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

e. DATE

b. SIGNATURE OF DETERMINING OFFICER

c. DATE

e. SIGNATURE OF APPROVING OFFICER

f. DATE

STANDARD FORM 123 (REV. 11/2015)
Prescribed by GSA FMR (41 CFR) 102-37

CERTIFICATIONS, AGREEMENTS, AND ASSURANCES
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 Inter State 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.
(c) When the property is picked up by or shipped to a State agency, the State
certifies that is 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 in usable and needed by
the donee.
(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.
(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.

personal property listed in block 12 is requested. It is hereby certified that (1) the
signer is appropriately authorized; (2) the property is usable and necessary 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 listen 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.
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 handicapped person shall solely by reason of the
handicap, 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.
(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
harmless and indemnify the Government for any and all costs, judgement, 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.

b. SERVICE EDUCATIONAL ACTIVITY. Pursuant to section 203(j) of the Act and
regulations promulgated thereunder, and a designation of

STATEMENT OF ADMINISTRATIVE ACTIONS
2. OFFICIAL SIGNING IN BLOCK 14b AS REPRESENTATIVE OF:
a. DEPARTMENT OF DEFENSE. The Department of Defense (DLA or Sponsoring
Military Service) has determined that the personal property listed in block 12 is
authorized and approved for donation to the service educational activity 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 listen 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.
3. OFFICIAL SIGNING IN BLOCK 14e AS REPRESENTATIVE OF GENERAL
SERVICES ADMINISTRATION: The surplus personal property listen in block 12,
except any disapproved items, is approved for transfer for donation purposes. Property
listen 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 no 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.

STANDARD FORM 123 (REV. 11/2015) BACK