Exhibit F Form 1364 Proposal to Lease Space Jan. 2023 REVISED 2024.pdf
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- Attached to
- X1DZ--Space for Lease at Ashtabula, OH for a CBOC 16, 218 RSF/ 13, 815 ABOA/ 12, 013 NUSF
- Solicitation number
- 36C24424R0066
About this file
This document is a GSA Form 1364 Proposal to Lease Space for a VA medical facility in Ashtabula, Ohio. The solicitation (Number 36C24424R0066) seeks approximately 16,218 rentable square feet (RSF), 13,815 ABOA square feet, and 12,013 net usable square feet (NUSF) for a Community-Based Outpatient Clinic (CBOC). Key proposal details include a requirement for the offeror to provide comprehensive information about the property, including building characteristics, accessibility, energy efficiency, parking, and potential renovation needs. The form requires detailed financial information such as shell rent, operating costs, tenant improvements, and potential parking fees, with options for various fee structures and lease terms. The proposal allows for flexibility in reporting building features like HVAC operations, seismic safety, historic status, and asbestos-containing materials, enabling potential lessors to provide comprehensive property information for VA consideration.
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Text version
a. Architectural/Engineering fees will be (choose one): b. Lessor's Project Management fee will be:
The RLP outlines how fees may apply. Fees are not applicable for turnkey pricing.
Percent of Total Construction Costs: % Percent of Total Construction Costs
Dollar Amount per NUSF: $
Flat Fee: $
PROPOSAL TO LEASE SPACE
(See Paperwork Reduction Act Statement in Section V)
This Offer is in response to Request for Lease Proposals (RLP) Number: 36C24424R0066
OMB Control Number: 3090-0086 Expiration Date: 1/31/2026
SECTION I - BUILDING OVERVIEW
1. Building Name 2. Building Street Address
3. City, State and 9-Digit ZIP Code 4. Number of Floors in Building
5. Total Rentable Square Feet (RSF) in Building
Building Space Breakout
a. General Purpose/Office: b. Warehouse: c. Other:
6. Total NUSF 7. Building Common Area Factor (CAF)
8. Total Building Parking Under Offeror's Control
a. Total Surface b. Total Structured c. Is all the parking onsite? d. Number of spaces required by local code, if applicable:
YES NO
(Parking spaces and associated costs offered to meet the requirements outlined in the RLP shall be detailed in Box 20).
SECTION II - PRIMARY OFFER DETAILS
9. NUSF of Offered Space 10. RSF of Offered Space 11. CAF of Offered Space 12. Floor(s) and/or Suite(s) of Offered Space
13. Full Term of the Lease
Months
14. Firm Term of the Lease
Months
After the Firm Term, the Government may terminate the Lease by providing advanced written notice to the Lessor. Indicate the minimum number of days the Government must provide prior written notice by.
15. Number of Days Notice
RENT TABLE
Enter initial rental figures only. Scheduled step rents for Shell rent and Parking rates must be entered in Section VI, Addendum.
16. Shell Rent
The initial Shell Rent is a total annual dollar amount of
Does the initial Shell Rent offered change during the term of the lease?
X.
Annual Rent
Y.
Annual Rate $ Per RSF
Z.
Annual Rate $ Per NUSF
YES NO
17. Operating Costs (Refer to Line 27 on the GSA 1217)
The Operating Cost base is a total annual dollar amount of
18. Tenant Improvement (TI) included in the Rent
a. TI Allowance per ABOA: $ (stated in RLP; leave blank for turnkey)
b. Total TI: $ (VA Pays Lump-SUM)
c. Amortization Interest Rate: % d. Amortization Period in Months:
19. Building Specific Amortized Capital (BSAC) Rent
a. BSAC Amount per NUSF: $
b. Total BSAC: $
(if stated in RLP)
('a' above multiplied by offered NUSF or total cost)
c. Amortization Interest Rate: % d. Amortization Period in Months:
20. Parking Required by the RLP
a. General $ per space per month b. Number of Surface: Spaces Offered:
c. General Structured:
e. Reserved per space per month
d. Number of
Spaces Offered:
f. Number of $0.00
Surface:
$ per space per month
Spaces Offered:
g. Reserved $ per space per month h. Number of Structured: Spaces Offered:
21. Rent for Non-Standard Circumstances
The RLP requires a non-standard rental component applicable only under specific conditions outlined in the Lease called:
Not Applicable
22. TOTAL INITIAL RENT
23. Fee Schedule
31. Heating, Ventilation, and Air Conditioning (HVAC) Overtime Rate
a. $ rate per hour -PER-
b. Select one of the options below: c. Total Number
Zone Floor Space of Zones, Floors, or Spaces
d. If the Government used 1 hour of overtime HVAC for the entire offered space, it would owe:
(Multiply 31a times 31c)
Land Site Size: SF or Acres Total Land Costs: $ (Choose one)
SECTION III - ADDITIONAL FINANCIAL ASPECTS OF THE OFFER
24. Are you offering free rent? a. If yes, enter the number of b. What rent components are included in the free rent?
YES NO free months being offered.
months Shell
Operating Costs
TI
BSAC
Parking
Non-Standard
27. Commissions If applicable, enter the commission distribution and ATTACH BROKER COMMISSION
AGREEMENT.
a. Tenant's Representative Commission %
b. Owner's Representative Commission %
28. Adjustment for Vacant Premises
$ per NUSF
29. Adjustment for Reduced Services
$ per NUSF
30. Tax Parcel Percent of Government Occupancy Explain complex tax
a. RSF of Tax Parcel RSF parcel arrangements in
b. Percent of Occupancy % Section VI, Addendum.
SECTION IV - BUILDING AND PROPERTY INFORMATION
32. In what year was the original building construction completed and ready for initial occupancy?
33. Provide the year and a brief description of the last major building renovation, if applicable.
34. Select the approximate level of construction necessary to meet the building shell requirements:
a. Improvements to the existing Building will be required to meet the Lease shell requirements.
The total approximate construction cost to achieve Lease shell standards is: $
b. The Building already meets all the Lease shell requirements; no improvements are necessary.
c. The requirements of the Lease will be satisfied through the construction of a new building.
35. What are the Building's normal hours of operations for HVAC included in the Operating Costs?
Start
End
Monday - Friday
Start
End
Saturday
Start
End
Sunday
36. With regard to Fire Protection and Life Safety:
a. The Property meets the Lease fire protection/life safety standards.
b. The Property will be improved to meet the Lease fire protection/life safety standards.
c. The Property does NOT meet the Lease fire protection/life safety standards and will NOT be upgraded.
37. With regard to Accessibility (Architectural Barriers Act Accessibility Standard - ABAAS):
a. The Property meets the Lease accessibility standards.
b. The Property will be improved to meet the Lease accessibility standards.
c. The Property does NOT meet the Lease accessibility standards and will NOT be upgraded.
38. With regard to Asbestos-Containing Material (ACM): (Select all that apply)
a. The Building contains no ACM.
b. The Building contains undamaged, nonfriable ACM.
c. The Building contains thermal system insulation ACM which is not damaged or subject to damage by routine operations.
d. The Building contains ACM that does not fall within any of the above categories.
e. The Building contains ACM; abatement will be completed prior to occupancy.
39. With regard to Flood Plains:
a. The Property is in a base (100 year) floodplain.
b. The Property is in a 500 year floodplain.
c. The Property is NOT in a floodplain.
25. Are you offering free space?
YES NO
a. If yes, how much free space, in addition to the space offered in Box 9 above, is being offered?
NUSF
26. Are you offering renewal options?
YES NO
If yes, fill out 'Renewal Options' in Section VI, Addendum.
Offeror's Signature Date Signed
40. With regard to Seismic Safety of the Building:
a. The RLP does NOT contain seismic requirements.
b. The Building either fully meets RLP seismic requirements or meets an exemption.
c. The Building will be retrofitted to meet RLP seismic requirements it does not currently meet.
d. The Building will be constructed to meet RLP seismic requirements.
e. The Building will NOT meet RLP seismic requirements.
41. With regard to ENERGY STAR®:
a. The Property has received the ENERGY STAR® Label within the past twelve months.
Date (MM/DD/YYYY):
b. The Property has NOT received the ENERGY STAR® Label within the past twelve months but falls into one of the following categories:
i. New construction
ii. Existing building that cannot obtain label due to insufficient occupancy
iii. Meets one of the statutory exceptions below:
(1) The agency would remain in the building it currently occupies.
(2) The Lease would be in a building of historical, architectural, or cultural significance listed or eligible to be listed on the National Register of Historic Places.
(3) The Lease is for 10,000 RSF or less.
With regard to offerors falling into a statutory exception category above, the Offeror has evaluated energy efficiency and conservation improvements and has determined:
(i) Cost effective improvements have been identified and are attached to this offer.
(ii) There are no cost effective improvements. Supporting documentation is attached to this offer.
42. With regard to Historic Preference:
a. Is the Building a Historic Property? YES NO
b. Is the Building within an Historic District? YES NO
43. With regard to Historically Underutilized Business Zones (HUBZone) Price Evaluation Preference:
a. I am a HUBZone Small Business Concern (SBC) Offeror and I elect to waive the price evaluation preference.
b. I am a HUBZone SBC Offeror and I do NOT waive the price evaluation preference.
c. I am NOT a HUBZone SBC Offeror. The question does not apply.
SECTION V - OWNER IDENTIFICATION AND OFFEROR CERTIFICATION
44. Recorded Owner Name 45. Owner Street Address 46. City, State and 9-Digit ZIP Code 47. Unique Entity Identifier (UEI)
48. Offeror Name 49. Offeror Street Address 50. City, State and 9-Digit ZIP Code 51. Contact Information
a. Email
b. Telephone
52. Offeror's Interest in the Property
Owner (Offeror and Recorded Owner are the same person)
Other (Explain if Other is selected)
Agent / Broker
By submitting this offer, the offeror agrees to lease the premises described within the offer to the United States of America upon the Lease Contracting Officer's acceptance of the offer. The offeror acknowledges they have read and fully understand the Request for Lease Proposals and agrees to honor the terms and conditions specified in their offer and to full compliance with and acceptance of the Request for Lease Proposals and its attachments.
By signing this form, you acknowledge having read the RLP with attachments in its entirety. No deviations are allowed unless authorized by the Lease Contracting Officer (LCO).
53. Does your offer request any deviation from the RLP? NO YES - I request a deviation from the LCO
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 3090-0086. We estimate that it will take 2.3 hours 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 (M1V1CB), 1800 F Street, NW, Washington, DC 20405.
C. Additional Tax Parcel Information
A. Soft Term / Non-Firm Term Rent
D. Additional Remarks or Conditions with Respect to this Offer
SECTION VI - ADDENDUM
Shell Rent and Parking steps should be detailed if the initial amount stated in the Rent Table above does NOT remain the same for the full term of the Lease. Shell Rent step amounts should be stated in Annual Rent for the entire Leased space.
Parking step rents should be stated as a dollar amount per space per month.
Term Years Shell Rate per NUSF Expense Rate per NUSF Shell-Expense Rate Total
Total Annual Rent
Is the offered space part of multiple tax bills or multiple buildings on a single tax parcel? YES NO
If 'YES', use the boxes below to account for the total number of buildings, associated RSF, and tax parcel associated with the overall space offered to the Government. Attach the legal description(s) of the offered property/properties as part of your overall RLP submission.
Building Building RSF Tax Parcel Tax Parcel ID Number
Any deviations from the RLP requirements must be requested prior to the request for final proposal revisions. If the Offeror requests any deviations, VA at its sole discretion will make the decision whether to accept the deviation.
GSA 1364 (REV. 1/2023)
| 1 Building Name: |
| 2 Building Street Address: |
| 3 City State and 9Digit ZIP Code: |
| 4 Number of Floors in Building: |
| undefined: |
| a General PurposeOffice: |
| b Warehouse: |
| c Other: |
| 6 Total ANSSIBOMS Occupant Area ABOA Square Feet SF in Building: |
| 7 Building Common Area Factor CAF: |
| b Total Structured: |
| c Is all the parking onsite: Off |
| d Number of spaces required by local code if applicable: |
| Parking spaces and associated costs offered to meet the requirements outlined in the RLP shall be detailed in Box 20: |
| 9 NUSF of Offered Space: |
| 10 RSF of Offered Space: |
| 11 CAF of Offered Space: |
| 12 Floors andor Suites of Offered Space: |
| Months: |
| Months_2: |
| Days Notice: |
| The initial Shell Rent is a total annual dollar amount of: |
| Does the initial Shell Rent offered change during the term of the lease: Off |
| X Annual Rent16 Shell Rent The initial Shell Rent is a total annual dollar amount of Does the initial Shell Rent offered change during the term of the lease YES NO: |
| Per RSF: |
| The Operating Cost base is a total annual dollar amount of: |
| X Annual Rent17 Operating Costs Refer to Line 27 on the GSA 1217 The Operating Cost base is a total annual dollar amount of: |
| Y Annual Rate Per RSF17 Operating Costs Refer to Line 27 on the GSA 1217 The Operating Cost base is a total annual dollar amount of: |
| Z Annual Rate Per NUSF17 Operating Costs Refer to Line 27 on the GSA 1217 The Operating Cost base is a total annual dollar amount of: |
| a TI Allowance per ABOA: |
| b Total TI: |
| c Amortization Interest Rate: |
| d Amortization Period in Months: |
| stated in RLP leave blank for turnkey: |
| a BSAC Amount per NUSF: |
| a above multiplied by offered NUSF or total cost: |
| b Total BSAC: |
| c Amortization Interest Rate_2: |
| d Amortization Period in Months_2: |
| undefined_2: |
| Spaces Offered: |
| undefined_3: |
| Spaces Offered_2: |
| undefined_4: |
| Spaces Offered_3: |
| undefined_5: |
| Spaces Offered_4: |
| 000: |
| 00021 Rent for NonStandard Circumstances The RLP requires a nonstandard rental component applicable only under specific conditions outlined in the Lease called Not Applicable: |
| 00022 TOTAL INITIAL RENT: |
| Percent of Total Construction Costs: Off |
| Dollar Amount per NUSF: Off |
| Flat Fee: Off |
| undefined_6: |
| undefined_7: |
| b Lessors Project Management fee will be Percent of Total Construction Costs: |
| undefined_8: |
| undefined_9: |
| SECTION III ADDITIONAL FINANCIAL ASPECTS OF THE OFFER: |
| YES_3: Off |
| NO_3: Off |
| Shell: Off |
| TI: Off |
| Parking: Off |
| free months being offered: |
| Operating Costs: Off |
| BSAC: Off |
| NonStandard: Off |
| space: Off |
| space offered in Box 9 above is being offered: |
| options: Off |
| Addendum: |
| undefined_10: |
| 30 Tax Parcel Percent of Government Occupancy: |
| Premises: |
| Services: |
| undefined_11: |
| 31 Heating Ventilation and Air Conditioning HVAC Overtime Rate: |
| PER: Off |
| Zone Floor Space: |
| or Spaces: |
| Multiply 31a times 31c: |
| SECTION IV BUILDING AND PROPERTY INFORMATION: |
| 32 In what year was the original building construction completed and ready for initial occupancy: |
| 34 Select the approximate level of construction necessary to meet the building shell requirements: |
| a Improvements to the existing Building will be required to meet the Lease shell requirements: Off |
| b The Building already meets all the Lease shell requirements no improvements are necessary: Off |
| c The requirements of the Lease will be satisfied through the construction of a new building: Off |
| The total approximate construction cost to achieve Lease shell standards is: |
| Land Site Size: |
| SF or: Off |
| Acres: Off |
| undefined_14: |
| Choose one: |
| Start: |
| Start_2: |
| Start_3: |
| undefined_15: |
| End: |
| End_2: |
| End_3: |
| a The Property meets the Lease fire protectionlife safety standards: Off |
| b The Property will be improved to meet the Lease fire protectionlife safety standards: Off |
| c The Property does NOT meet the Lease fire protectionlife safety standards and will NOT be upgraded: Off |
| 37 With regard to Accessibility Architectural Barriers Act Accessibility Standard ABAAS: |
| a The Property meets the Lease accessibility standards: Off |
| b The Property will be improved to meet the Lease accessibility standards: Off |
| c The Property does NOT meet the Lease accessibility standards and will NOT be upgraded: Off |
| 38 With regard to AsbestosContaining Material ACM Select all that apply: |
| a The Building contains no ACM: Off |
| b The Building contains undamaged nonfriable ACM: Off |
| c The Building contains thermal system insulation ACM which is not damaged or subject to damage by routine: Off |
| d The Building contains ACM that does not fall within any of the above categories: Off |
| e The Building contains ACM abatement will be completed prior to occupancy: Off |
| 39 With regard to Flood Plains: |
| a The Property is in a base 100 year floodplain: Off |
| b The Property is in a 500 year floodplain: Off |
| c The Property is NOT in a floodplain: Off |
| a The RLP does NOT contain seismic requirements: Off |
| b The Building either fully meets RLP seismic requirements or meets an exemption: Off |
| c The Building will be retrofitted to meet RLP seismic requirements it does not currently meet: Off |
| d The Building will be constructed to meet RLP seismic requirements: Off |
| e The Building will NOT meet RLP seismic requirements: Off |
| a The Property has received the ENERGY STAR Label within the past twelve months: Off |
| b The Property has NOT received the ENERGY STAR Label within the past twelve months but falls into one of the: Off |
| Date MMDDYYYY: |
| i: Off |
| ii: Off |
| iii Meets one of the statutory exceptions below: Off |
| 1 The agency would remain in the building it currently occupies: Off |
| 2 The Lease would be in a building of historical architectural or cultural significance listed or eligible to be listed: Off |
| 3 The Lease is for 10000 RSF or less: Off |
| i Cost effective improvements have been identified and are attached to this offer: Off |
| ii There are no cost effective improvements Supporting documentation is attached to this offer: Off |
| a Is the Building a Historic Property: Off |
| b Is the Building within an Historic District: Off |
| a I am a HUBZone Small Business Concern SBC Offeror and I elect to waive the price evaluation preference: Off |
| b I am a HUBZone SBC Offeror and I do NOT waive the price evaluation preference: Off |
| c I am NOT a HUBZone SBC Offeror The question does not apply: Off |
| 44 Recorded Owner Name: |
| 45 Owner Street Address: |
| 46 City State and 9Digit ZIP Code: |
| 47 Unique Entity Identifier UEI: |
| 48 Offeror Name: |
| 49 Offeror Street Address: |
| 50 City State and 9Digit ZIP Code: |
| a Email: |
| b Telephone: |
| Owner Offeror and Recorded Owner are the same person: Off |
| Other Explain if Other is selected: Off |
| Agent Broker: Off |
| NO_8: Off |
| YES I request a deviation from the LCO: Off |
| Offeror s Signature: |
| Date Signed: |
| SECTION VI ADDENDUM: |
| Term YearsRow1: |
| Shell Rate per NUSFRow1: |
| Expense Rate per NUSFRow1: |
| ShellExpense Rate TotalRow1: |
| Total Annual RentRow1: |
| Term YearsRow2: |
| Shell Rate per NUSFRow2: |
| Expense Rate per NUSFRow2: |
| ShellExpense Rate TotalRow2: |
| Total Annual RentRow2: |
| Term YearsRow3: |
| Shell Rate per NUSFRow3: |
| Expense Rate per NUSFRow3: |
| ShellExpense Rate TotalRow3: |
| Total Annual RentRow3: |
| Term YearsRow4: |
| Shell Rate per NUSFRow4: |
| Expense Rate per NUSFRow4: |
| ShellExpense Rate TotalRow4: |
| Total Annual RentRow4: |
| Term YearsRow5: |
| Shell Rate per NUSFRow5: |
| Expense Rate per NUSFRow5: |
| ShellExpense Rate TotalRow5: |
| Total Annual RentRow5: |
| Term YearsRow6: |
| Shell Rate per NUSFRow6: |
| Expense Rate per NUSFRow6: |
| ShellExpense Rate TotalRow6: |
| Total Annual RentRow6: |
| Term YearsRow7: |
| Shell Rate per NUSFRow7: |
| Expense Rate per NUSFRow7: |
| ShellExpense Rate TotalRow7: |
| Total Annual RentRow7: |
| Term YearsRow8: |
| Shell Rate per NUSFRow8: |
| Expense Rate per NUSFRow8: |
| ShellExpense Rate TotalRow8: |
| Total Annual RentRow8: |
| Term YearsRow9: |
| Shell Rate per NUSFRow9: |
| Expense Rate per NUSFRow9: |
| ShellExpense Rate TotalRow9: |
| Total Annual RentRow9: |
| Term YearsRow10: |
| Shell Rate per NUSFRow10: |
| Expense Rate per NUSFRow10: |
| ShellExpense Rate TotalRow10: |
| Total Annual RentRow10: |
| If YES use the boxes below to account for the total number of buildings associated RSF and tax parcel associated with the: Off |
| BuildingRow1: |
| Building RSFRow1: |
| Tax ParcelRow1: |
| Tax Parcel ID NumberRow1: |
| GSA 1364 REV 12023: |
| Per NUSF: |
| Text2: |
File details come from the government source that posted it. Updated .