6 - EXHIBIT E - GSA Form 1217 Lessor Annual Cost.pdf
PDF 120 KB Posted
- Solicitation number
- 36C24825R0031
About this file
The document is a GSA Form 1217 Lessor's Annual Cost Statement, which is a standardized form used to estimate and document annual costs associated with leasing a property to the federal government. The form is part of Solicitation Number 36C248-25-R-0031 for a new lease for a Primary Care Annex in West Palm Beach, Florida. It provides a comprehensive breakdown of estimated annual costs across multiple categories including cleaning services, utilities (heating, electrical, plumbing, air conditioning), elevator maintenance, building management, security, taxes, insurance, and other miscellaneous expenses.
The form is designed to allow the lessor to provide detailed cost estimates for both the entire building and the government-leased area, with columns for documenting expenses in categories ranging from salaries and supplies to system maintenance and repair. The bottom section includes a certification area for the lessor to attest to the accuracy of the cost estimates, with spaces for title, name, signature, and date. This document serves as a financial transparency tool in the federal leasing process, helping to itemize and validate the annual operating costs associated with a potential government lease.
View the file
Other files
Show all 31
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
GSA Public Buildings Service
EXHIBIT E
Page 1 of 2 GSA FORM 1217 1994-electronic ver.
LESSOR’S ANNUAL COST STATEMENT
1. REQUEST FOR LEASE PROPOSALS NUMBER 36C248-25-R-0031 2. STATEMENT DATE
3. RENTABLE AREA (SQ. FT.) 3A. ENTIRE BUILDING 3B. LEASED BY
GOV'T
4. BUILDING NAME BUILDING STREET
CITY STATE ZIP CODE
SECTION I - ESTIMATED ANNUAL COST OF SERVICES & UTILITIES FURNISHED BY LESSOR AS PART OF RENTAL
CONSIDERATION
SERVICES AND UTILITIES LESSOR'S ANNUAL COST FOR:
ENTIRE BUILDING
(a)
GOV'T-LEASED AREA
(b)
GOV’T USE ONLY
(c)
A. CLEANING, JANITOR AND/OR CHAR SERVICE
5. SALARIES
6. SUPPLIES (wax, cleansers, cloths, etc.)
7. CONTRACT SERVICES (Window washing, waste and snow removal)
B. HEATING
8. SALARIES
9. FUEL ("x" one)
___OIL ___GAS ___COAL ___ELECTRIC
10. SYSTEM MAINTENANCE AND REPAIR
C. ELECTRICAL
11. CURRENT FOR LIGHT AND POWER (Including elevators)
12. REPLACEMENT OF BULBS, TUBES, STARTERS
13. POWER FOR SPECIAL EQUIPMENT
14. SYSTEM MAINTENANCE AND REPAIR (Ballasts, fixtures, etc.)
D. PLUMBING
15. WATER (For all purposes) (Include sewage charges)
16. SUPPLIES (Soap, towels, tissues not in 6 above)
17. SYSTEM MAINTENANCE AND REPAIR
E. AIR CONDITIONING
18. UTILITIES (Include electricity, if not in C11)
19. SYSTEM MAINTENANCE AND REPAIR
Page 2 of 2 GSA FORM 1217 1994-electronic ver.
F. ELEVATORS
20. SALARIES (Operators, starters, etc.)
21. SYSTEM MAINTENANCE AND REPAIR
G. MISCELLANEOUS
22. BUILDING ENGINEER AND/OR MANAGER
23. SECURITY (Watchmen, guards, not janitors)
24. SOCIAL SECURITY TAX AND WORKMEN'S
COMPENSATION INSURANCE
25. LAWN AND LANDSCAPING MAINTENANCE
26. OTHER (Explain on separate sheet)
27. TOTAL
SECTION II - ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES
28. REAL ESTATE TAXES
29. INSURANCE (Hazard, liability, etc.)
30. BUILDING MAINTENANCE AND RESERVES FOR
REPLACEMENT
31. LEASE COMMISSION
32. MANAGEMENT
33. TOTAL:
LESSOR'S CERTIFICATION - The amounts entered in Columns (a) and (b) represent my best estimate as to the annual costs of services, utilities, and ownership.
TITLE NAME SIGNATURE DATE
34A. (Check one)
34B. 34C. 34D.
35A. (Check one)
35B. 35C. 35D.
File details come from the government source that posted it. Updated .