Template GSA Form 3626 Short Form (Oct. 2021).docx.pdf

U.S. GOVERNMENT LEASE FOR REAL PROPERTY

(Short Form)

1a.LEASE NUMBER 1b. BUILDING NUMBER

PART I - OFFER (Offeror completes Section A, C and D; Government shall complete Section B)

NOTE: All offers are subject to the terms and conditions outlined in Request for Lease Proposals No. , Supplemental Lease Requirements document, General Clauses (GSA Form 3517A), and any other attachments included herein.

A. LOCATION AND DESCRIPTION OF PREMISES OFFERED FOR LEASE BY GOVERNMENT

1. NAME AND ADDRESS OF

BUILDING (Include nine-digit ZIP Code)

2. LOCATION(S) IN BUILDING

2a. FLOOR(S) 2b. ROOM NUMBER(S) 2e NUMBER OF PARKING SPACES

OFFERED

STRUCTURED

SURFACE

ANNUAL PARKING RATES (IF NOT

INCLUDED IN RATES UNDER PART C

BELOW)

STRUCTURED /space SURFACE /space

2c. SQ. FT.

RENTABLE

ABOA

Common Area Factor

2d. TYPE

☐ GENERAL OFFICE

☐ WAREHOUSE

☐ OTHER (Specify)

B. TERM

3a. To have and to hold the said Premises with its appurtenances for the term beginning upon acceptance of the Premises as required by this Lease and continuing for a period of Years, Years Firm, subject to termination and renewal rights as may be hereinafter set forth. The commencement date of this Lease, along with any applicable termination and renewal rights, shall be more specifically set forth in a Lease Amendment upon substantial completion and acceptance of the Space by the Government.

3b. The Government may terminate this Lease, in whole or in parts, at any time effective after the Firm Term of this Lease, by providing not less than days prior written notice to the Lessor. The effective date of the termination shall be the day following the expiration of the required notice period or the termination date set forth in the notice, whichever is later. No rental shall accrue after the effective date of termination.

3c. This Lease may be renewed at the option of the Government for a term of YEARS at the rental rate(s) set forth below, provided notice is given to the Lessor at least days before the end of the original Lease term; all other terms and conditions of this Lease, as same may have been amended, shall remain in full force and effect during any renewal term.

C. RENTAL

4. Rent shall be payable in arrears and will be due on the first workday of each month. When the date for commencement of the lease falls after the 15th day of the month, the initial rental payment shall be due on the first workday of the second month following the commencement date. Rent for a period of less than a month shall be prorated. Rent shall not be adjusted for changes in real estate taxes or operating costs.

5a.AMOUNT OF ANNUAL RENT 5b.RATE PER MONTH

RENTAL RATE BREAKDOWN FIRM TERM

($/RSF/YEAR)

NON-FIRM TERM

($/RSF/YEAR)

RENEWAL TERM

($/RSF/YEAR)

6. BUILDING SHELL RENT

(INCL. REAL ESTATE TAXES)

6a. $ 6b. Same as 6a 6c. $

7. OPERATING RENT 7a. $ 7b. Same as 7a 7b. Same as 7a

8. TURNKEY TENANT

IMPROVEMENT RENT

(See blocks 12 and 13 below for additional breakdown of cost and amortization rate )

8a. $ 8b. $0.00 8c. $0.00

9. BUILDING SPECIFIC

AMORTIZED CAPITAL (IF

APPLICABLE)

9a. $ 9b. $0.00 9c. $0.00

10. TOTAL RENT 10a. $ 10b. $ 10c. $

11. TENANT IMPROVEMENT COSTS 12. INTEREST RATE TO AMORTIZE TENANT

IMPROVEMENTS

13. HVAC OVERTIME RATE PER HOUR 14. ADJUSTMENT FOR VACANT PREMISES RATE

($/ABOA SF/YEAR)

GENERAL SERVICES ADMINISTRATION GSA FORM 3626 (REV 10/21)

DRAFT C

OPY

D. OWNER IDENTIFICATION AND CERTIFICATION

15. RECORDED OWNER

15a. Name

15b. Unique Entity Identifier (UEI)

15c. Address

15d. City

15e. State

15f. ZIP + 4

16. 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

17. OFFEROR’S INTEREST IN PROPERTY

☐ OWNER ☐ AUTHORIZED AGENT ☐ OTHER (Specify)

18. OFFEROR ☐ Check if same as Recorded Owner

18a. NAME

18b. ADDRESS

18c. CITY

18d. STATE

18e. ZIP + 4

18f. Title

18g. E-mail address

18h. Telephone Number

18i. OFFEROR’S SIGNATURE

18j. DATE SIGNED

PART II - AWARD (To be completed by Government)

1. Your offer is hereby accepted. This award consummates the Lease, which consists of the following attached documents: (a) this GSA Form 3626,

(b) Supplemental Lease Requirements, (c) Security Requirements, (d) Agency Specific Requirements, (e) Floor Plan delineating the Premises, (f) GSA Form 3517A, General Clauses (Acquisition of Leasehold Interests in Real Property for Small Leases), and (g) the following building improvements, changes or additions made or agreed to by you (for example, energy efficiency and conservation improvements, ABAAS upgrades, Seismic Form C - Building Retrofit or New Construction Pre-Award Commitment (if applicable)):

2. THIS DOCUMENT IS NOT BINDING ON THE GOVERNMENT OF THE UNITED STATES OF AMERICA UNLESS SIGNED BELOW BY

AUTHORIZED LEASE CONTRACTING OFFICER.

3a.NAME OF LEASE CONTRACTING OFFICER (Type or Print)

3b.SIGNATURE OF LEASE

CONTRACTING OFFICER

3c. DATE

GENERAL SERVICES ADMINISTRATION GSA FORM 3626 (REV 10/21)

DRAFT C

OPY