EXHIBIT G_ FORM 1217 2016.pdf

GSA Form 1217 is a Lessor's Annual Cost Statement template used to document the estimated annual costs associated with leased federal real estate. The form requires lessors to provide detailed cost information for services, utilities, and building ownership across two primary sections. Section I captures estimated annual costs for services and utilities furnished by the lessor as part of rental consideration, including cleaning and janitorial services, heating, electrical, plumbing, air conditioning, elevators, and miscellaneous services such as building engineering, security, lawn maintenance, and social security/workers' compensation insurance. Section II documents estimated annual ownership costs exclusive of capital charges, including real estate taxes, hazard and liability insurance, building maintenance and reserves, lease commissions, and management expenses. Lessors must provide cost estimates for both the entire building and the government-leased area separately.

The form requires lessors to identify the property by name and address, provide a statement date, and specify whether the leased area represents the entire building or a portion thereof. Lessors must certify that all amounts entered represent their best cost estimates or actual costs from the previous year. The form includes detailed instructions for calculating rentable area using standard measurement methodology and guidance for allocating costs appropriately between the full building and government-occupied space. This OMB-approved form (3090-0086) with an expiration date of 1/31/2026 is essential for GSA's determination of fair market rental rates and ensures that lease pricing remains consistent with prevailing market scales in the community.