GSA 1217 (REV. 11/2016) – LESSOR'S ANNUAL COST STATEMENT

This is a General Services Administration (GSA) form used by property lessors to provide the federal government with annual cost statements for leased space. The form requires lessors to document the estimated annual costs of services, utilities, and ownership expenses associated with rental properties offered to the government. The statement is organized into two primary sections: Section I captures estimated annual costs for services and utilities furnished by the lessor as part of rental consideration, including cleaning/janitorial services, heating, electrical, plumbing, air conditioning, elevators, and miscellaneous items such as building engineer/manager salaries, security, and lawn maintenance. Section II requires documentation of estimated annual ownership costs exclusive of capital charges, including real estate taxes, insurance, building maintenance and reserves, lease commissions, and management expenses. The form requests identification of both the entire building rental area and the specific government-leased area, measured to the inside finish of permanent outer building walls or corridor walls.

Lessors must provide detailed cost breakdowns for each service and utility category, either as actual costs from the previous year or as best-estimate projections, and certify the accuracy of submitted information by signature of the owner or legal agent. The form explicitly states that GSA policy is to enter into leases only at rental charges consistent with prevailing market rates in the community. Instructions clarify that Section I costs apply regardless of whether services are furnished by the government or lessor, while Section II information is used by the government to determine fair market value of the space being leased. OMB Control Number 3090-0086; Expiration Date: 1/31/2026.