6 - Exhibit E - GSA Form 1217 Lessor Annual Cost.pdf
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- Solicitation number
- 36C24825R0093
About this file
The document is a GSA Form 1217 Lessor's Annual Cost Statement for a lease proposal (RLP # 36C248-25-R-0093) related to a Veterans Affairs medical facility in St. Thomas, U.S. Virgin Islands. The form is designed to capture detailed estimated annual costs for building services and ownership expenses, including categories such as cleaning, heating, electrical systems, plumbing, air conditioning, elevators, security, maintenance, real estate taxes, and insurance. The form provides a comprehensive breakdown of potential costs for both the entire building and the government-leased area, with columns for lessor's annual costs and spaces for certification by the property owner or legal agent.
This cost statement is part of a solicitation for a medical office lease requiring 5,410-5,500 ABOA square feet in St. Thomas, with specific geographic boundaries, parking requirements, and occupancy conditions. The lease opportunity is for up to 10 years, with space needed by October 1, 2026. Only existing buildings are considered, with preference for modernized spaces. Responses were due by 3:00 PM ET on September 1, 2025, to be submitted via email to Javier Correa-Ochoa, the Lease Contracting Officer at the Department of Veterans Affairs Network Contracting Office 8. Offerors must provide detailed documentation including property location, ownership verification, parking availability, flood plain status, and potential socio-economic status qualifications.
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Text version
GSA Public Buildings Service
Page 1 of 2 GSA FORM 1217 1994-electronic ver.
RLP # 36C248-25-R-0093 – EXHIBIT E
LESSOR’S ANNUAL COST STATEMENT
1. REQUEST FOR LEASE PROPOSALS NUMBER 36C248-25-R-0093 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.
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