Exhibit H - Proposal to Lease Space - GSA Form 1364.pdf

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X1DB--Extend RLP 36C25224R0071 Close Date to Sept. 6th
Solicitation number
36C25224R0071
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This document is a GSA Form 1364 Proposal to Lease Space in response to Request for Lease Proposals (RLP) Number 36C252-24-R-0071 for the Department of Veterans Affairs (VA) to operate a Community Based Outpatient Clinic in Freeport, Illinois. The VA is seeking 8,450 to 9,999 ABOA square feet of medical office space for a 20-year fully serviced lease with a 10-year firm term. The lease is set aside for Service-Disabled, Veteran-Owned Small Businesses (SDVOSB). The offeror must provide details on the building, proposed rental rates, tenant improvements, operating costs, parking, and other lease terms. Interested SDVOSB parties must respond by August 30, 2024. The new lease is estimated to be awarded before September 30, 2024.

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PAGE 1 of 3 GSA FORM 1364 (REV 04/22)

PROPOSAL TO LEASE SPACE In Response to Request for Lease Proposals (RLP) Number 36C252-24-R-0071 DATED

SECTION I - DESCRIPTION OF PREMISES

1. BUILDING

DESCRIPTION

a. Building Name b. Building Street Address

c. City d. State f. Congressional District e. 9-Digit ZIP Code

2a. FLOORS OFFERED 2b. TOTAL NUMBER

OF FLOORS IN BUILDING

3. TOTAL RENTABLE SPACE IN OFFERED BUILDING

a. GENERAL PURPOSE (Office)

b. WAREHOUSE c. OTHER

_____ SF _____ SF _____ SF

4. LIVE FLOOR LOAD 5. MEASUREMENT

METHOD

6. YEAR OF LAST

MAJOR RENOVATION

(if applicable)

7. BUILDING AGE 8. SITE SIZE

_____ Pounds per SF ANSI/BOMA

OTHER

_____ _____ _____ SF

_____ Acres

SECTION II - SPACE OFFERED AND RATES

9. ANSI/BOMA OFFICE AREA

SQUARE FEET (ABOA)

10. RENTABLE SQUARE FEET

(RSF)

11. COMMON AREA FACTOR (CAF)

“Tenant Improvements” are all alterations for the Government-demised area above the building shell buildout, excluding costs identified as tenant improvements in the Security Unit Price List. Building Specific Amortized Capital (BSAC) is the sum of costs identified as such in the Security Unit Price List. Neither the Tenant Improvements as stated in Block 12, nor the BSAC as stated in Block 13, are to be included in the shell rent. It is expected that the tenant buildout will be fully amortized at the end of the firm term, and the rent will be reduced accordingly. Any desired rent increases or decreases beyond the firm term of the lease should be reflected in the shell rate and fully explained as part of this written proposal. If Tenant Improvements or BSAC improvements are to be amortized beyond the firm term, those calculations must be itemized as part of this written proposal. The Offeror may attach additional pages as necessary.

Number of years each cost per square foot is in effect. State any changes for any rent component.

a.

BUILD-OUT COSTS PER

CATEGORY

b.

AMORTIZATION

TERM

c.

AMORTIZATION

INTEREST RATE

d.

ANNUAL RENT

$ PER RSF

e.

ANNUAL RENT

$ PER ABOA SF

f.

NUMBER YEARS

RATE IS

EFFECTIVE

12. TENANT IMPROVEMENTS

(per RLP requirements) $ ________ ________ ________ $ ________ $________ ________

13. BSAC

(per RLP requirements) $ ________ ________ ________ $ ________ $________ ________

14. SHELL BUILD-OUT

(per RLP requirements) $ ________

15. TOTAL BUILD-OUT COSTS

16. SHELL RENT (Including real estate taxes. Refer to Line 28 on GSA Form 1217) $ ________ $ ________ ________

17. OPERATING COSTS (Refer to Line 27 on GSA Form 1217) $ ________ $ ________

18. TOTAL RATE/SF $ ________ $ ________ ________

19. TOTAL ANNUAL RENT $

PER SF RATE FOR YEARS PER SF RATE FOR YEARS PER SF RATE FOR YEARS

20. STEP RENT (SHELL RATES)

$__________/RSF

$__________/ABOA

10 Thru 15

$________/RSF

$________/ABOA

15 Thru 20

21. PARKING

a. Number of parking spaces for the entire building/ facility which are under the control of the Offeror: ________ Surface ________ Structured

b. Number of parking spaces required by local code: ________ Surface ________ Structured

c. Number of parking spaces for Employee/Visitor Use (per RLP): ________ Surface ________ Structured

d. Number of parking spaces for Official Government Vehicles (per RLP): ________ Surface ________ Structured

e. Does the rental rate offered above include RLP-required parking costs?

YES NO If NO, complete the following: Annual cost per space: $ ________ Surface $ ________ Structured

PAGE 2 of 3 GSA FORM 1364 (REV 04/22)

SECTION III - LEASE TERMS AND CONDITIONS

22. INITIAL LEASE TERM

(Full Term)

23. RENEWAL OPTIONS

a. Number of Years b. Years Firm c. Number of Days Notice for Government to Terminate Lease

a. Shell Rate / RSF / Yr

b. Years Each

c. Number of Options

d. Number of Days Notice to Exercise Option:

90 $ ______ 30

24. OFFER GOOD UNTIL AWARD 25. Space will be altered and delivered in accordance with the Government's specifications and requirements in accordance with the Request for Lease Proposals (RLP) and the lease.

26. COMMISSIONS (If applicable), ATTACH COMMISSION AGREEMENT

a. Tenant Representative Commission: b. Owner’s Representative Commission: c. Schedule of Commission Payments:

______ % ______ % ______ % at lease award and ______ % at lease occupancy

27. OFFEROR’S TENANT IMPROVEMENT FEE SCHEDULE*

*Block 27 fees only applicable for TI subject to post-award pricing.; N/A for turnkey pricing

a. Architectural/Engineering fees will be (choose one):

1. $ ______ per ABOA SF

2. ______ % of Total TI construction costs

3. $ ______ flat fee

b. Lessor’s Project Management Fee will be ______ percent of Total TI construction costs

c. If other fees are applicable, state as per ABOA square foot, or if using a percentage, the basis for determining the fee.

The Government will add the cost of the proposed TI fees to the net present value of the offered rental rate as described in the RLP’s Present Value Price Evaluation paragraph. This schedule will be applicable for Tenant Improvements.

28. ADDITIONAL FINANCIAL ASPECTS OF THE LEASE

Adjustment for Vacant Premises: $________ per ABOA SF

Adjustment for Reduced Services: $________ per ABOA SF*

*Only applies when Government requires extended services, such as 24/7 HVAC, beyond normal operating hours (check RLP/Lease for confirmation). Reflects reduction if Government no longer requires these extended services.

HVAC Overtime Rate: $________ per hour per zone floor space (choose one)

For rates based on a “per zone” basis, provide the following:

Number of zones in offered Space: ______

Building’s Normal Hours of HVAC Operation:

Monday - Friday _____ AM to ____ PM

Saturday _____ AM to _____PM

Sunday _____ AM to _____PM

Percent of Government Occupancy: _________%

Current Year Taxes: $_________ (Matches GSA 1217, Block 28)

Based on fully assessed value? Yes No

Is the offered space part of multiple tax bills or multiple buildings on an single tax parcel? Yes No

If so, provide tax ID numbers and SF for each. Attach the legal description of the offered property.

If a site is offered, state the total land costs: $________

29. FREE RENT INCLUDED IN OFFER

1. ______ months free rent (includes shell, operating, TI and BSAC rent)

2. Other rental concessions structured as follows ______

3. None

30. LIST OF ATTACHMENTS SUBMITTED WITH THIS OFFER (See RLP requirements)

31. ADDITIONAL REMARKS OR CONDITIONS WITH RESPECT TO THIS OFFER

SECTION IV - OWNER IDENTIFICATION AND CERTIFICATION

32. RECORDED OWNER

a. Name b. Address c. City d. State e. ZIP +4 f. Unique Entity Identifier (UEI)

33. BY SUBMITTING THIS OFFER, THE OFFEROR AGREES UPON ACCEPTANCE OF THIS PROPOSAL BY HEREIN SPECIFIED DATE, TO LEASE TO THE UNITED STATES OF AMERICA, THE PREMISES DESCRIBED, UPON THE TERMS AND CONDITIONS AS SPECIFIED HEREIN, IN FULL COMPLIANCE WITH AND ACCEPTANCE OF THE

AFOREMENTIONED RLP, WITH ATTACHMENTS.

I have read the RLP with attachments in its entirety and am requesting no deviations.

34. Offeror’s Interest in Property Owner Agent Other _____________________________________

35. OFFEROR Check if same as Recorded Owner

a. Name b. Address c. City d. State e. ZIP + 4

f. Title g. E-Mail Address h. Telephone Number

i. Offeror’s Signature j. Date Signed

PAGE 3 of 3 GSA FORM 1364 (REV 04/22)

LEASE PROPOSAL DATA

In Response to Request for Lease Proposals (RLP) Number DATE:

1 Offeror's Interest in the Property:

Fee owner Other:

Attach evidence of Offeror's interest in property (e.g., deed) and representative's authority to bind Offeror.

2 Flood Plains:

The Property is in a base (100-year) flood plain in a 500-year flood plain not in a flood plain.

(See RLP Section 2, Flood Plains.)

3 Seismic Safety: The Building RLP does not contain seismic requirements. No documentation required.

RLP contains seismic requirements. The Building

Fully meets seismic requirements or meets an exemption under the RLP Does not meet seismic requirements, but will be retrofitted to meet seismic requirements Will be constructed to meet seismic requirements Will not meet seismic requirements

(See RLP Section 2, Seismic Safety.) Attach appropriate documentation.

4 Historic Preference: The Building is a Historic property within a historic district.

Non-historic developed site or non-historic undeveloped site within a historic district.

Historic property outside of a historic district.

None of the above.

(See RLP Section 2, Historic Preference.) Attach appropriate documentation.

5 Asbestos-Containing Material (ACM): The Property Contains no ACM, or contains ACM in a stable, solid matrix that is not damaged or subject to damage.

Contains ACM not in a stable, solid matrix.

(See RLP Section 2, Asbestos.)

6 Fire/Life Safety:

The Property Meets Does not meet Lease fire/life safety standards.

(See RLP Section 2, Fire Protection and Life Safety.)

7 Accessibility:

The Property Meets Does not meet Lease accessibility standards.

(See RLP Section 2, Accessibility.)

8 ENERGY STAR®: The Building

Has received the ENERGY STAR® Label within the past twelve months. Date (MM-DD-YYYY): __________ Has not received the ENERGY STAR® Label within the past twelve months; the Offeror has evaluated energy savings measures and Determined that none are cost effective.

Determined that the following are cost effective (Attach additional pages):

(See RLP Section 2, Energy Independence and Security Act.)

9 Waiver of Price Evaluation Preference. A HUBZone small business concern (SBC) Offeror may elect to waive the price evaluation preference provided in Section 4 of the RLP. In such a case, no price evaluation preference shall apply to the evaluation of the HUBZone SBC, and the performance of work requirements set forth in Section 1 of the Lease shall not be applicable to a lease awarded to the HUBZone SBC Offeror under this solicitation. A HUBZone SBC desiring to waive the price evaluation preference should so indicate below.

I am a HUBZone SBC Offeror and I elect to waive the price evaluation preference.

(See RLP and Lease documents for more information)

DATED:
10 RENTABLE SQUARE FEET:
undefined_3:
undefined_18:
Line 27 on GSA Form 1217:
undefined_23:
undefined_24:
fill_65:
10 Thru 15:
15 Thru 20:
undefined_27:
Structured:
Surface:
Structured_2:
Surface_2:
Structured_3:
e Does the rental rate offered above include RLPrequired parking costs: Off
NO: Off
Structured_4:
Surface_3:
Structured_5:
21 PARKINGRow1:
a Number of parking spaces for the entire building facility which are under the control of the Offeror Surface Structured b Number of parking spaces required by local code Surface Structured c Number of parking spaces for EmployeeVisitor Use per RLP Surface Structured d Number of parking spaces for Official Government Vehicles per RLP Surface Structured e Does the rental rate offered above include RLPrequired parking costs YES NO If NO complete the following Annual cost per space Surface StructuredRow1:
ArchitecturalEngineering fees will be choose one: Off
per ABOA SF:
AM to:
AM to_2:
PM:
AM to_3:
PM_2:
Matches GSA 1217 Block 28: Off
Is the offered space part of multiple tax bills or multiple buildings on an single tax: Off
2 Other rental concessions structured as follows: Off
3 None: Off
30 LIST OF ATTACHMENTS SUBMITTED WITH THIS OFFER See RLP requirements:
months free rent includes shell operating TI and BSAC rent:
undefined_32:
31 ADDITIONAL REMARKS OR CONDITIONS WITH RESPECT TO THIS OFFER:
32 RECORDED OWNER:
a Name:
b Address:
c City:
d State:
e ZIP 4:
f Unique Entity Identifier UEI:
undefined_33: Off
undefined_35: Off
undefined_36:
undefined_37: Off
a Name:
b Address_2:
c City_2:
d State_2:
e ZIP 4:
f Title:
g EMail Address:
h Telephone Number:
i Offerors Signature:
j Date Signed:
LEASE PROPOSAL DATA:
DATE:
1_3:
Has received the ENERGY STAR Label within the past twelve months Date MMDDYYYY:
undefined_17:
undefined_22:
undefined_21:
undefined_26:
at lease occupancy:
at lease award and:
Number of zones in offered Space:
If a site is offered state the total land costs:
undefined_34: Off
1_2: Off
2_2:
undefined_19:
undefined_2:
undefined_29:

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