EXHIBIT G_ FORM 1217 2016.pdf

This is GSA Form 1217 (REV. 11/2016), the Lessor's Annual Cost Statement, used in federal real property lease proposals and negotiations.

The form requires lessors to document estimated annual costs for services, utilities, and building ownership associated with leased space offered to the General Services Administration (GSA). Section I captures estimated annual costs for services and utilities including cleaning/janitorial service, heating, electrical systems, plumbing, air conditioning, elevators, building management, security, and miscellaneous services—with separate columns for entire building costs versus government-leased area costs. Section II requires documentation of ownership costs exclusive of capital charges, including real estate taxes, insurance, building maintenance and reserves for replacement, lease commissions, and management expenses. The form identifies the rental property by square footage (entire building and government-leased area), building name and address, and requires lessor certification with signature authority designated as either owner or legal agent. Instructions specify that rentable area measurements follow GSA standards based on inside finish of permanent outer building walls to inside finish of corridor walls, and that lessors must identify which services and utilities will be furnished as part of the rental consideration. The form emphasizes GSA policy of entering leases only at rental charges consistent with prevailing community market scales for facilities. Completion is required regardless of whether Section I applies, and lessors may consolidate cost data by major service category if detailed records are not separately maintained.