6 - Exhibit E - GSA Form 1217 Lessor Annual Cost.pdf
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- Attached to
- X1AA--FY26 New/Replacement Lease: Ceiba CBOC
- Solicitation number
- 36C24825R0110
About this file
This is a GSA Form 1217 Lessor's Annual Cost Statement for a Request for Lease Proposals (RLP # 36C248-25-R-0110) related to a Department of Veterans Affairs medical space lease in Ceiba, Puerto Rico. The form is a detailed template for lessors to provide estimated annual costs for services, utilities, and ownership of a proposed building, including categories such as cleaning, heating, electrical, plumbing, air conditioning, elevators, and miscellaneous expenses. The form allows the lessor to itemize costs for the entire building and the government-leased area, with sections for service costs, utility expenses, and ownership-related expenses exclusive of capital charges.
The associated federal contract opportunity seeks 15,250 to 15,308 square feet of medical office space in Ceiba, Puerto Rico, with a minimum of 87 parking spaces. The lease term can be up to 15 years, with both new and existing buildings considered. The space must be ready for occupancy by September 1, 2026, and must be located within specific geographic boundaries. Offers are due by 3:00 PM ET on August 11, 2025, and must be submitted via email to Javier Correa-Ochoa. Socio-economic preferences are noted for Service-Disabled Veteran Owned Small Businesses (SDVOSB) and Veteran Owned Small Businesses (VOSB), with specific documentation requirements for such businesses.
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Text version
GSA Public Buildings Service
Page 1 of 2 GSA FORM 1217 1994-electronic ver.
RLP # 36C248-25-R-0110 – EXHIBIT E
LESSOR’S ANNUAL COST STATEMENT
1. REQUEST FOR LEASE PROPOSALS NUMBER 36C248-25-R-0110 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 .