Exhibit_H_--_GSA_FORM_1217_Lessor's_Annual_Cost_Statement.doc

GSA Form DOC document 77 KB Posted

Attached to
Sources sought for Clinical/Admin Space
Solicitation number
HHSNNICHD6600
Issued by

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Lessor's Annual Cost Statement GSA Form 1217

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Other versions and copies of GSA Form 1217

457 government files on GovTribe name GSA Form 1217. Different revisions are separate documents; copies of this exact file point search engines to its first posting.

File Revision Posted Attached to
06 RLP 36C10F26R0024 GSA Form 1217 Lessors Annual Cost Statement SPB County FL OPC 7_17_2026.pdf 2026 X1DB--South Palm Beach County, FL OPC 56, 076 ANSI/BOMA
06 RLP 36C10F26R0024 GSA Form 1217 Lessors Annual Cost Statement SPB County FL OPC 7_17_2026.pdf 2026 X1DB--South Palm Beach County, FL OPC 56, 076 ANSI/BOMA
F - GSA Form 1217 Lessor Annual Cost Statement (Nov. 2016).pdf Nov 2016 General Services Administration (GSA) seeks to lease office space in Brunswick, GA
Exhibit G_GSA Form 1217 (Nov. 2016).pdf Nov 2016 General Services Administration (GSA) seeks to lease Warehouse, Office, Light Industrial, and Wareyard space in Sumner, WA
Exhibit G - GSA Form 1217 Lessors Annual Cost Statement (Nov. 2016).pdf Nov 2016 U. S. Government Seeks Proposals to Lease 2, 405 to 2, 605 ABOA SQ FT of Office and Related Space in Washington, DC
Exhibit G_GSA Form 1217 (Nov. 2016).pdf Nov 2016 General Services Administration (GSA) seeks to lease office space in Portland, OR
Exhibit G_GSA Form 1217 (Nov. 2016).pdf Nov 2016 Request for Lease Proposal (RLP): Las Vegas, NV Medical Facility
4WY0059_Exhibit 3 GSA Form 1217 Lessors Annual Cost Statement (Nov. 2016).pdf Nov 2016 U. S. Government Seeks to Lease Office Space in Cheyenne, WY – Solicitation Amendment No. 1
Exhibit G - GSA Form 1217 Lessors Annual Cost Statement (Nov. 2016).pdf Nov 2016 General Services Administration (GSA) seeks to lease the following space: Solicitation No. 6GA0308
EXHIBIT G - GSA Form 1217 - Lessor_s Annual Cost Statement (Nov. 2016).pdf Nov 2016 Request for Lease Proposals (RLP) - Saipan CBOC
Exhibit I- GSA Form 1217 Lessors Annual Cost Statement.pdf Revision not stated Anchorage Air Force Reserve Recruiting Office
GSA Form 1217 Lessors Annual Cost Statement.pdf Revision not stated General Services Administration (GSA) Seeks To Lease The Following Space:
Exhibit G - GSA Form 1217 Lessors Annual Cost Statement.pdf Revision not stated General Services Administration (GSA) seeks to lease office space in Port Angeles, WA and Sequim, WA
Exhibit G GSA Form 1217 Lessor Annual Cost Statement.pdf Revision not stated General Services Administration (GSA) seeks to lease 8, 161 USF- 8, 405 USF of office space in South Portland, Maine. Please see attachments for requirements and RLP Package.
G. GSA Form 1217 Lessor's Annual Cost Statement (1).pdf Revision not stated General Services Administration (GSA) Seeks to lease the following space: Solicitation No. 2TX1269
07. GSA Form 1217 - Lessor's Annual Cost Statement.pdf Revision not stated X1DB--Santa Cruz Outpatient Clinic, New Procurement Lease Package
Exhibit I- GSA Form 1217 Lessors Annual Cost Statement.pdf Revision not stated Anchorage Air Force Reserve Recruiting Office
Exhibit I- GSA Form 1217 Lessors Annual Cost Statement.pdf Revision not stated Wasilla Armed Forces Recruiting Office
11 GSA Form 1217 080626.pdf Revision not stated U. S. Department of Agriculture Seeks to Lease Office and Related Space in Huntington, Indiana
06 - GSA Form 1217 - Lessors Annual Cost Statement.pdf Revision not stated X1DB--Canton OH Outpatient Clinic 62, 784 ANSI/BOMA RLP Extension
Show all 20

Who attaches GSA Form 1217

Agency Files
General Services Administration Public Buildings Service Central Office 164
Department of the Army Corps of Engineers Engineering District Seattle 72
Department of Agriculture Under Secretary for Farm Production and Conservation 25
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 24
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8 20
General Services Administration Public Buildings Service Central Office Office of Leasing 18
Department of Veterans Affairs Office of Construction and Facilities Management 17
Department of the Army Corps of Engineers Engineering District Alaska 14

Other files

File Type Posted
Exhibit_J_--_GSA_FORM_12000_-_Prelease_FPLS_Evaluation_(PartA B).docx DOCX document
Exhibit_D--_Facility_Security_Level_II.pdf PDF
Exhibit_I_--_GSA_Form_3518-SAM_Reps_and_Certs_Addendum.docx DOCX document
Exibit-A_HHSNNICHD6600_NIH_-_Standard_Lease_Form_L201C_NICHD6089.docx DOCX document
Exhibit_E_--_3516_Solicitation_Provisions.pdf PDF
Exhibit_C---HHSNNICHD6600_Program_Of_Requirements_(POR)_11-22-16.pdf PDF
Exhibit_G_--_Global_Proposal_to_Lease_Space_Form_1364.docx DOCX document
Exhibit_K_--_Security_Unit_Price_List_FSL_II.xlsx XLSX spreadsheet
Exhibit_B_--_NIH_Agency_Minimum_Technical_Requirements.pdf PDF
Exhibit_L_--_ModelSubcontracting_Plan.doc DOC document
HHSNNICHD6600_CLINICAL_SPACE_GSA_R100-11-22-16.pdf PDF
EXHIBIT_F__GSA_FORM_3517B_GEBERAL.pdf PDF
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Department of ealth & Human Services (NIH) Page 2 / 2

Lessor’s Annual Cost Statement

1. SOLICITATION FOR OFFERS
2. STATEMENT DATE
3. RENTABLE AREA (SQ. FT.)
3A. ENTIRE BUILDING
3B. LEASED BY GOV'T
4. BUILDING NAME
BUILDING STREET
CITY
STATE
ZIP CODE

SECTION I - ESTIMATED ANNUAL COST OF SERVICES & UTILITIES FURNISHED BY LESSOR AS PART OF RENTAL CONSIDERATION

SERVICES AND UTILITIES
LESSOR'S ANNUAL COST FOR:
ENTIRE BUILDING (a)
GOV'T-LEASED AREA (b)
GOV’T USE ONLY (c)

A. CLEANING, JANITOR AND/OR CHAR SERVICE

5. Salaries

6. SUPPLIES (wax, cleansers, cloths, etc.)

7. CONTRACT SERVICES (Window washing, waste and snow removal)

B. HEATING

8. SALARIES

9. FUEL ("x" one) ___OIL ___GAS ___COAL ___ELECTRIC

10. SYSTEM MAINTENANCE AND REPAIR

C. ELECTRICAL

11. CURRENT FOR LIGHT AND POWER (Including elevators)

12. REPLACEMENT OF BULBS, TUBES, STARTERS

13. POWER FOR SPECIAL EQUIPMENT

14. SYSTEM MAINTENANCE AND REPAIR (Ballasts, fixtures, etc.)

D. PLUMBING

15. WATER (For all purposes) (Include sewage charges)

16. SUPPLIES (Soap, towels, tissues not in 6 above)

17. SYSTEM MAINTENANCE AND REPAIR

E. AIR CONDITIONING

18. UTILITIES (Include electricity, if not in C11)

19. SYSTEM MAINTENANCE AND REPAIR

F. ELEVATORS

20. SALARIES (Operators, starters, etc.)

21. SYSTEM MAINTENANCE AND REPAIR

G. MISCELLANEOUS

22. BUILDING ENGINEER AND/OR MANAGER

23. SECURITY (Watchmen, guards, not janitors)

24. SOCIAL SECURITY TAX AND WORKMEN'S COMPENSATION INSURANCE

25. LAWN AND LANDSCAPING MAINTENANCE

26. OTHER (Explain on separate sheet)

27. TOTAL
$0.00
$0.00
$0.00

SECTION II - ESTIMATED ANNUAL COST OF OWNERSHIP EXCLUSIVE OF CAPITAL CHARGES

28. REAL ESTATE TAXES

29. INSURANCE (Hazard, liability, etc.)

30. BUILDING MAINTENANCE AND RESERVES FOR REPLACEMENT

31. LEASE COMMISSION

32. MANAGEMENT

33. TOTAL
$0.00
$0.00
$0.00

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.

TITLE
NAME
SIGNATURE
DATE

34A. (Check one)

34B.
34C.
34D.

35A. (Check one)

35B.
35C.
35D.

GSA FORM 1217 1994-electronic ver.

File details come from the government source that posted it. Updated .