Exhibit G - Form 1217 - Lessors Annual Cost Statement.pdf
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- Solicitation number
- 36C24826R0103
About this file
This is GSA Form 1217 (Lessor's Annual Cost Statement), a General Services Administration template used to document estimated annual costs associated with leased federal office space. The form is designed to support GSA's policy of entering into leases only at rental charges consistent with prevailing community scales for facilities.
The form comprises two primary sections. Section I requires lessors to itemize estimated annual costs of services and utilities furnished as part of rental consideration, including cleaning and janitorial services, heating, electrical, plumbing, air conditioning, and elevator services. For each service category, lessors must provide cost estimates in two columns: one for the entire building and one specifically for the government-leased area. Section II requires documentation of estimated annual ownership costs exclusive of capital charges, encompassing real estate taxes, hazard and liability insurance, building maintenance and reserves for replacement, lease commissions, and management expenses. Items 28 through 32 in Section II must be completed regardless of Section I applicability, as these costs inform the government's determination of fair market value for the leased space. The form requires lessors to provide separate line-item costs where records permit, though major category totals may be entered if detailed records are unavailable. The form includes certification language requiring the lessor (owner or legal agent) to attest that entered amounts represent their best estimate of annual service, utility, and ownership costs. OMB Control Number 3090-0086 is valid through February 28, 2029, with an estimated completion time of 2 hours.
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LESSOR'S ANNUAL COST STATEMENT
Important - Read attached "Instructions"
OMB Control Number: 3090-0086 Expiration Date: 2/28/2029
4. Building Name and Address (Number, Street, City, State, and Zip Code)
SECTION I - ESTIMATED ANNUAL COST OF SERVICES AND UTILITIES
FURNISHED BY LESSOR AS PART OF RENTAL CONSIDERATION
3. Rental Area (Square Feet)
SERVICES AND UTILITIES
A. CLEANING, JANITOR AND/OR CHAR SERVICE
B. HEATING
C. ELECTRICAL
D. PLUMBING
5. Salaries
FOR GOVERNMENT
USE ONLY
LESSOR'S ANNUAL COST FOR
(a) Entire Building
8. Salaries
10. System Maintenance and Repair
11. Current for Light and Power
12. Replacement of Bulbs, Tires, Starters
13. Power for Special Equipment
9. Fuel ("X" one)
E. AIR CONDITIONING
F. ELEVATORS
GSA 1217 (REV. 11/2016)
6. Supplies (Wax, cleaners, cloths, etc.)
7. Contract Services (Window washing, waste and snow removal)
14. System Maintenance and Repair (Ballasts, Fixtures, etc.)
15. Water (For all purposes) (Include Sewage Charges)
16. Supplies (Soap, towels, tissues not in 6 above)
(b) Government-Leased Area
3A. Entire Building
2. Statement Date
3B. Leased by Government
1. Request for Lease Proposals (RLP)
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 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 (MVCB), 1800 F Street, NW, Washington, DC 20405.
17. System Maintenance and Repair
18. Utilities (Include electricity, if not in C11)
19. System Maintenance and Repair
21. System Maintenance and Repair
GENERAL SERVICES ADMINISTRATION
20. Salaries (Operators, starters, etc.)
Oil Gas Coal Electric
G. MISCELLANEOUS (To the extent not included on Page 1)
22. Building Engineer and/or Manager
23. Security (Watchperson, guards, not janitors)
25. Lawn and Landscaping Maintenance
26. Other (Explain on separate sheet)
27. TOTAL
34. Signature of:
28. Real Estate Taxes
29. Insurance (Hazard, Liability, etc.)
30. Building Maintenance and Reserves for Replacement
31. Lease Commission
32. Management
TYPED NAME AND TITLE SIGNATURE DATE
34C.
35A. 35B. 35C.
LESSOR'S CERTIFICATION - The amounts entered in Columns (a) and (b) represent my best estimate as to the annual costs of services, utilities, and ownership.
33. TOTAL
34A.
24. Social Security Tax and Workperson's Compensation Insurance
SECTION II - ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES
34B.
GSA 1217 (REV. 11/2016) PAGE 2
Owner Legal Agent
INSTRUCTIONS
In acquiring space by lease, it is the established policy of GSA to enter into leases only at rental charges which are consistent with prevailing scales in the community for facilities.
ITEM NUMBER
SECTION I
ESTIMATED ANNUAL COST OF SERVICES AND UTILITIES
SECTION II
ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES
1. Enter the Government lease or Request for Lease Proposals (RLP) number, if available.
2. Enter the date that your statement was prepared and signed.
3. A. Enter in this block a computation of the rentable area (multiple tenancy basis) for the entire building. The rentable area shall be computed by measurement to the inside finish of permanent outer building walls to the inside finish of corridor walls (actual or proposed) or to other permanent partitions, or both. Rentable space is the area for which a tenant is charged rent. It is determined by the building owner and may vary by city or by building within the same city. The rentable space may include a share of building support/common areas such as elevator lobbies, building corridors, and floor service areas. Floor services areas typically include restrooms, janitor rooms, telephone closets, electrical closets, and mechanical rooms.
The rentable space generally does not include the vertical building penetrations and their enclosing walls, such as stairs, elevator shafts, and vertical ducts.
3. B. Enter in this block a computation of the rentable area to be rented to the Government. For this area, follow the procedure as outlined above, except that measurements are to be made only to the center of the partitions which separate the area to be rented by the Government from adjoining rented or rentable areas.
4. Identify the property by name and address.
5. - 26. The services and utilities listed in this section are required in most of our rented space whether furnished by the Government or the Lessor.
Carefully review the Request for Lease Proposals (RLP) and/or the proposed lease to identify those services and utilities to be furnished by you as part of the rental consideration. Then enter your best cost estimate, or the actual cost from the previous year, for each of these services and utilities in column (a) for the entire building and in column (b) for the area to be rented to the Government. If any service or utility furnished for the space rented by the Government is not furnished throughout the building, or the cost of a service or utility furnished to the Government space exceeds the cost of the same service or utility furnished to other rented space, explain on a separate sheet. For convenience, each major category has been divided into separate items such as salaries and supplies so that they may be entered when applicable. However, in the event that your records are not maintained for each item contained in Section I, 5 through 26, the total for a major category (A through F) may be entered under the category heading in columns (a) and (b) in lieu of the specific items. System maintenance and repairs includes the annual cost of such items as oiling, inspecting, cleaning, regulating, and routine replacement costs.
Items 28 through 32 will be useful in the Government's determination of the fair market value of the space to be rented and shall be completed irrespective of whether Section I is applicable, as follows:
28. Include all applicable real estate taxes imposed upon the property.
29. Enter the annual cost of fire, liability, and other insurance carried on the real estate.
31. Enter any lease commission which you may be responsible for due to the Government leasing action.
32. Include administrative expenses such as agency fees, legal fees, auditing, and advertising. Do not include financial charges such as income or corporate taxes or organization expense.
34. - 35. Complete Lessor certification.
30. Enter the annual cost of wages, materials, and outside services used in repairs and maintenance of the building itself and all similar repairs and maintenance of the building itself and all similar repairs and maintenance costs not included in Section I above (Heating, Electrical, Plumbing, Air Conditioning, and Elevators). This includes major repairs and changes in the nature of a permanent improvement such as annual cost to replace relatively short-lived items such as boiler, compressors, elevators, and roof coverings.
GSA 1217 (REV. 11/2016) PAGE 3
LESSOR'S ANNUAL COST STATEMENT
Important - Read attached "Instructions" OMB Control Number: 3090-0086 Expiration Date: 2/28/2029
4. Building Name and Address (Number, Street, City, State, and Zip Code) SECTION I - ESTIMATED ANNUAL COST OF SERVICES AND UTILITIES FURNISHED BY LESSOR AS PART OF RENTAL CONSIDERATION
3. Rental Area (Square Feet)
SERVICES AND UTILITIES
A. CLEANING, JANITOR AND/OR CHAR SERVICE
B. HEATING
C. ELECTRICAL
D. PLUMBING
5. Salaries
FOR GOVERNMENT USE ONLY
LESSOR'S ANNUAL COST FOR
(a) Entire Building
8. Salaries
10. System Maintenance and Repair
11. Current for Light and Power
12. Replacement of Bulbs, Tires, Starters
13. Power for Special Equipment
9. Fuel ("X" one)
E. AIR CONDITIONING
F. ELEVATORS
GSA 1217 (REV. 11/2016)
6. Supplies (Wax, cleaners, cloths, etc.)
7. Contract Services (Window washing, waste and snow removal)
14. System Maintenance and Repair (Ballasts, Fixtures, etc.)
15. Water (For all purposes) (Include Sewage Charges)
16. Supplies (Soap, towels, tissues not in 6 above)
(b) Government-Leased Area 3A. Entire Building
2. Statement Date 3B. Leased by Government
1. Request for Lease Proposals (RLP) 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 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 (MVCB), 1800 F Street, NW, Washington, DC 20405.
17. System Maintenance and Repair
18. Utilities (Include electricity, if not in C11)
19. System Maintenance and Repair
21. System Maintenance and Repair
GENERAL SERVICES ADMINISTRATION
20. Salaries (Operators, starters, etc.)
G. MISCELLANEOUS (To the extent not included on Page 1)
22. Building Engineer and/or Manager
23. Security (Watchperson, guards, not janitors)
25. Lawn and Landscaping Maintenance
26. Other (Explain on separate sheet)
27. TOTAL
34. Signature of:
28. Real Estate Taxes
29. Insurance (Hazard, Liability, etc.)
30. Building Maintenance and Reserves for Replacement
31. Lease Commission
32. Management
TYPED NAME AND TITLE
SIGNATURE
DATE
LESSOR'S CERTIFICATION - The amounts entered in Columns (a) and (b) represent my best estimate as to the annual costs of services, utilities, and ownership.
33. TOTAL
24. Social Security Tax and Workperson's Compensation Insurance
SECTION II - ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES
GSA 1217 (REV. 11/2016) PAGE 2
INSTRUCTIONS
In acquiring space by lease, it is the established policy of GSA to enter into leases only at rental charges which are consistent with prevailing scales in the community for facilities.
ITEM NUMBER
SECTION I
ESTIMATED ANNUAL COST OF SERVICES AND UTILITIES
SECTION II
ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES
1. Enter the Government lease or Request for Lease Proposals (RLP) number, if available.
2. Enter the date that your statement was prepared and signed.
3. A. Enter in this block a computation of the rentable area (multiple tenancy basis) for the entire building. The rentable area shall be computed by measurement to the inside finish of permanent outer building walls to the inside finish of corridor walls (actual or proposed) or to other permanent partitions, or both. Rentable space is the area for which a tenant is charged rent. It is determined by the building owner and may vary by city or by building within the same city. The rentable space may include a share of building support/common areas such as elevator lobbies, building corridors, and floor service areas. Floor services areas typically include restrooms, janitor rooms, telephone closets, electrical closets, and mechanical rooms.
The rentable space generally does not include the vertical building penetrations and their enclosing walls, such as stairs, elevator shafts, and vertical ducts.
3. B. Enter in this block a computation of the rentable area to be rented to the Government. For this area, follow the procedure as outlined above, except that measurements are to be made only to the center of the partitions which separate the area to be rented by the Government from adjoining rented or rentable areas.
4. Identify the property by name and address.
5. - 26. The services and utilities listed in this section are required in most of our rented space whether furnished by the Government or the Lessor. Carefully review the Request for Lease Proposals (RLP) and/or the proposed lease to identify those services and utilities to be furnished by you as part of the rental consideration. Then enter your best cost estimate, or the actual cost from the previous year, for each of these services and utilities in column (a) for the entire building and in column (b) for the area to be rented to the Government. If any service or utility furnished for the space rented by the Government is not furnished throughout the building, or the cost of a service or utility furnished to the Government space exceeds the cost of the same service or utility furnished to other rented space, explain on a separate sheet. For convenience, each major category has been divided into separate items such as salaries and supplies so that they may be entered when applicable. However, in the event that your records are not maintained for each item contained in Section I, 5 through 26, the total for a major category (A through F) may be entered under the category heading in columns (a) and (b) in lieu of the specific items. System maintenance and repairs includes the annual cost of such items as oiling, inspecting, cleaning, regulating, and routine replacement costs.
Items 28 through 32 will be useful in the Government's determination of the fair market value of the space to be rented and shall be completed irrespective of whether Section I is applicable, as follows:
28. Include all applicable real estate taxes imposed upon the property.
29. Enter the annual cost of fire, liability, and other insurance carried on the real estate.
31. Enter any lease commission which you may be responsible for due to the Government leasing action.
32. Include administrative expenses such as agency fees, legal fees, auditing, and advertising. Do not include financial charges such as income or corporate taxes or organization expense.
34. - 35. Complete Lessor certification.
30. Enter the annual cost of wages, materials, and outside services used in repairs and maintenance of the building itself and all similar repairs and maintenance of the building itself and all similar repairs and maintenance costs not included in Section I above (Heating, Electrical, Plumbing, Air Conditioning, and Elevators). This includes major repairs and changes in the nature of a permanent improvement such as annual cost to replace relatively short-lived items such as boiler, compressors, elevators, and roof coverings.
GSA 1217 (REV. 11/2016) PAGE 3
11.0.0.20130303.1.892433.887364 GSA 1217 - Lessor's Annual Cost Statement
| 4. Enter the Building Name and Address (Number, Street, City, State, and Zone Improvement Plan (ZIP) Code): |
| 5a. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Salaries for the Entire Building. : |
| 5b. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Salaries for the Government-Leased Area. : |
| 5. Cleaning, Janitor and/or Char Service. Salaries: For Government Use Only.: |
| 11a. Electrical. Enter the Lessor's Annual Cost for Current for Light and Power for the Entire Building.: |
| 11b. Electrical. Enter the Lessor's Annual Cost for Current for Light and Power for the Government-Leased Area.: |
| 11. Electrical. Enter the Lessor's Annual Cost for Current for Light and Power For Government Use Only.: |
| 8a. Heating. Enter the Lessor's Annual Cost for Salaries for the Entire Building. : |
| 8b. Heating. Enter the Lessor's Annual Cost for Salaries for the Government-Leased Area.: |
| 8. Heating. Salaries: For Government Use Only.: |
| 15a. Plumbing. Enter the Lessor's Annual Cost for Water (for all purposes) (include Sewage Charges) for the Entire Building. : |
| 15b. Plumbing. Enter the Lessor's Annual Cost for Water (For all purposes) (Include Sewage Charges) for the Government-Leased Area.: |
| 15. Plumbing. Water (For All Purposes) (Include Sewage Charges) For Government Use Only.: |
| 18a. Air Conditioning. Enter the Lessor's Annual Cost for Utilities (Include Electricity, if not in C11) for the Entire Building.: |
| 20b. Elevators. Enter the Lessor's Annual Cost for Salaries (Operators, starters, etc.) for the Government-Leased Area.: |
| 20. Elevators. Salaries (Operators, starters, etc.) For Government Use Only.: |
| 20a. Elevators. Enter the Lessor's Annual Cost for Salaries (Operators, starters, etc.) for the Entire Building. : |
| 18b. Air Conditioning. Enter the Lessor's Annual Cost for Utilities (Include electricity, if not in C11) for the Government-Leased Area.: |
| 18. Air Conditioning. Utilities (include electricity if not in C11) For Government Use only.: |
| 6a. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Supplies (Wax, cleaners, cloths, etc.) for the Entire Building. : |
| 6b. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Supplies (Wax, cleaners, cloths, etc.) for the Government-Leased Area.: |
| 6. Supplies (Wax, cleaners, cloths, etc.) For Government Use Only.: |
| 7a. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Contract Services (Window washing, waste and snow removal) for the Entire Building. : |
| 7b. Cleaning, Janitor and/or Char Service. Enter the Lessor's Annual Cost for Contract Services (Window washing, waste and snow removal) for the Government-Leased Area.: |
| 7. Contract Services (Window washing, waste, and snow removal) For Government Use Only.: |
| 9a. Heating. Enter the Lessor's Annual Cost for Fuel for the Entire Building. : |
| 9b. Heating. Enter the Lessor's Annual Cost for Fuel for the Government-Leased Area.: |
| 9. Heating. Fuel: For Government Use Only.: |
| 10a. Heating. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Entire Building. : |
| 10b. Heating. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Government-Leased Area.: |
| 10. Heating. System Maintenance and Repair For Government Use Only.: |
| 12a. Electrical. Enter the Lessor's Annual Cost for Replacement of Bulbs, Tires, and Starters for the Entire Building. : |
| 12b. Electrical. Enter the Lessor's Annual Cost for Replacement of Bulbs, Tires, and Starters for the Government-Leased Area.: |
| 12. Electrical. Replacement of Bulbs, Tires and Starters For Government Use Only.: |
| 13a. Electrical. Enter the Lessor's Annual Cost for Power for Special Equipment for the Entire Building.: |
| 13b. Electrical. Enter the Lessor's Annual Cost for Power for Special Equipment for the Government-Leased Area.: |
| 13. Electrical. Enter the Lessor's Annual Cost for Power for Special Equipment For Government Use Only. : |
| 14a. Electrical. Enter the Lessor's Annual Cost for System Maintenance and Repair (Ballasts, Fixtures, etc.) for the Entire Building. : |
| 14b. Electrical. Enter the Lessor's Annual Cost for System Maintenance and Repair (Ballasts, Fixtures, etc.) for the Government-Leased Area. : |
| 14. Electrical. Enter the Lessor's Annual Cost for System Maintenance and Repair (Ballasts, Fixtures, etc.) For Government Use Only. : |
| 16a. Plumbing. Enter the Lessor's Annual Cost for Supplies (Soap, towels, tissues not in 6 above) for the Entire Building.: |
| 16b. Plumbing. Enter the Lessor's Annual Cost for Supplies (Soap, towels, tissues not in 6 above) for the Government-Leased Area.: |
| 16. Plumbing. Enter the Lessor's Annual Cost for Supplies (Soap, towels, tissues not in 6 above) For Government Use Only.: |
| 3. Enter the Rental Area in Square Feet.: |
| 3A. Enter the Entire Building info.: |
| 2. Enter the Statement Date (enter 2 digit month, 2 digit day, and 4 digit year).: |
| 3B. Enter the Leased by Government info.: |
| 17. Plumbing. System Maintenance and Repair For Government Use Only.: |
| 19a. Air Conditioning. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Entire Building.: |
| 19b. Air Conditioning. Enter the Lessor's Annual Cost for System Maintenance and Repair for Government-Leased Area.: |
| 19. Air Conditioning. System Maintenance and Repair for Government Use Only. : |
| 21a. Elevators. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Entire Building.: |
| 21b. Elevators. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Government-Leased Area. : |
| 21. Elevators. Enter the Lessor's Annual Cost for System Maintenance and Repair For Government Use Only. : |
| 17b. Plumbing. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Government-Leased Area.: |
| 17a. Plumbing. Enter the Lessor's Annual Cost for System Maintenance and Repair for the Entire Building. : |
| Heating. Click here to choose Oil as the fuel type.: 0 |
| Heating. Click here to choose Gas as the fuel type. : 0 |
| Heating. Click here to choose Coal as the fuel type.: 0 |
| Heating. Click here to choose Electric as the fuel type. : 0 |
| 22. Miscellaneous. Building Engineer and/or Manager For Government Use Only: |
| 22b. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Building Engineer and/or Manager for the Government-Leased Area.: |
| 22a. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Building Engineer and/or Manager for the Entire Building. : |
| 23. Security (Watchperson, guards, not janitors) For Government Use Only.: |
| 25a. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Lawn and Landscaping Maintenance for the Entire Building. : |
| 25b. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Lawn and Landscaping Maintenance for the Government-Leased Area. : |
| 25. Miscellaneous. Lawn and Landscaping Maintenance for Government Use Only.: |
| 26a. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Other (Explain on separate sheet) for the Entire Building.: |
| 26b. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Other (Explain on separate sheet) for the Government-Leased Area. : |
| 26. Miscellaneous. Other (Explain on separate sheet) for Government Use Only.: |
| 27a. Total for the Entire Building, Section I (this field is auto-calculated).: |
| 27b. Total for the Government-Leased Area, Section I (this field is auto-calculated).: |
| 27. Total, Section I, for Government Use Only.: |
| 28a. Enter the Lessor's Annual Cost for Real Estate Taxes for the Entire Building.: |
| 28b. Enter the Lessor's Annual Cost for Real Estate Taxes for the Government-Leased Area.: |
| 28. Real Estate Taxes for Government Use Only.: |
| 29a. Enter the Lessor's Annual Cost for Insurance (Hazard, Liability, etc.) for the Entire Building.: |
| 29b. Enter the Lessor's Annual Cost for Insurance (Hazard, Liability, etc.) for the Government-Leased Area.: |
| 29. Insurance (Hazard, Liability, etc.) for Government Use Only.: |
| 30a. Enter the Lessor's Annual Cost for Building Maintenance and Reserves for Replacement for the Entire Building. : |
| 30b. Enter the Lessor's Annual Cost for Building Maintenance and Reserves for Replacement for the Government-Leased Area.: |
| 30. Building Maintenance and Reserves for Replacement for Government Use Only.: |
| 31a. Enter the Lessor's Annual Cost for Lease Commission for the Entire Building. : |
| 31b. Enter the Lessor's Annual Cost for Lease Commission for the Government-Leased Area.: |
| 31. Lease Commission for Government Use Only.: |
| 35c. If you are the person who entered their Name and Title in 35A, enter the date you signed this form (enter 2 digit month, 2 digit day, and 4 digit year).: |
| 34a. Enter the First Typed Name and Title. : |
| 34b. Sign here if you are the person who entered their Name and Title in 34A (First Signature).: |
| 32a. Enter the Lessor's Annual Cost for Management for the Entire Building.: |
| 32b. Enter the Lessor's Annual Cost for Management for the Government-Leased Area.: |
| 32. Management for Government Use Only.: |
| 33a. Total for the Entire Building, Section II (this field is auto-calculated).: |
| 33b. Total for the Government-Leased Area, Section II (this field is auto-calculated).: |
| 33. Total, Section II, for Government Use Only.: |
| 24a. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Social Security Tax and Workperson's Compensation Insurance for the Entire Building. : |
| 24b. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Social Security Tax and Workperson's Compensation Insurance for the Government-Leased Area. : |
| 24. Miscellaneous. Social Security Tax and Workperson's Compensation Insurance For Government Use Only.: |
| 23b. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Security (Watchperson, guards, not janitors for the Government-Leased area.: |
| 23a. Miscellaneous (to the extent not included on Page 1). Enter the Lessor's Annual Cost for Security (Watchperson, guards, not janitors) for the Entire Building.: |
| Click here to mark the signature of the Lessor's Certification as the Owner. : 0 |
| Click here to mark the signature of the Lessor's Certification as the Legal Agent. : 0 |
File details come from the government source that posted it. Updated .