EXHIBIT G_ FORM 1217 2016.pdf

This is a GSA Form 1217 (Lessor's Annual Cost Statement), a template used by property owners to report estimated annual costs for services, utilities, and building ownership associated with leased federal space.

The form captures two primary cost categories. Section I requires lessors to provide estimated annual costs for services and utilities furnished as part of the rental consideration, including cleaning and janitorial services, heating, electrical, plumbing, air conditioning, elevators, and miscellaneous services such as building engineer/manager, security, and lawn maintenance. Costs must be itemized separately for the entire building and the government-leased area, with detailed line items for salaries, supplies, contract services, fuel type, maintenance, and repairs for each utility category. Section II requires documentation of estimated annual ownership costs exclusive of capital charges, including real estate taxes, insurance, building maintenance and reserves for replacement, lease commission, and management expenses. The form requires lessor certification and signature, with space for both owner and legal agent authorization. Instructions specify that rental charges must be consistent with prevailing market scales in the community, and define measurement standards for computing rentable area. This form supports GSA's policy of entering into leases at rates reflecting fair market value and assists in government determination of appropriate rental pricing for federally leased facilities.