JULY 2005
SOLICITATION FOR OFFERS
OUTPATIENT CLINIC
SFO NO. V101-183R-xxx-xxx-xx
[INSERT LOCATION OF FACILITY]
EXHIBIT I
MAINTENANCE COST WORKSHEET
2. BUILDING NAME AND ADDRESS (No., street, city, state, and zip code)
1. SOLICITATION FOR OFFERS
PART I ANNUAL OPERATING EXPENSES
MATERIALS
Labor
Total
A. Cleaning, Janitor and/or Char Service
3. Salaries (Enter on Line 5 GSA form 1217)
4. Supplies (wax, cleaners, cloths, etc.) (Enter on Line 6 GSA
form 1217)
5. Contract Services (window washing, waste and snow
removal) (Enter on Line 7 GSA form 1217)
B. Heating System Maintenance and Repair
6. Salaries (Enter on Line 8 GSA form 1217)
7. Filters, belts, lubricants, fluids, supplies
8. Labor (includes contracted work)
9. Subtotal Heating System (Add Lines 7 and 8. Enter result here and on Line 10 GSA form 1217)
C. Electrical System Maintenance and Repair
10. Bulbs, Tubes, Starters (Enter on Line 12 GSA form 1217)
11. Ballasts, fixtures, devices, etc.
12. Small tools and expendable supplies
13. Labor (includes contracted work)
14. Subtotal Electrical System (Add Lines 11 to 13. Enter result here and on Line 14 GSA form 1217)
D. Plumbing System Maintenance and Repair
15. Soap, towels, tissues not in Line 4 above (Enter on Line 16 GSA form 1217)
16. Fixtures, pipe and fittings
17. Small tools and expendable supplies
18. Labor (includes contracted work)
19. Subtotal Plumbing System (Add Lines 16 to 18. Enter result here and on Line 17 GSA form 1217)
E. Air Conditioning System Maintenance and Repair
20. Filters, belts, lubricants, fluids, supplies
21. Labor (includes contracted work)
22. Subtotal A/C System (Add Lines 20 to 21. Enter result here and on Line 19 GSA form 1217)
F. Elevators
23. Salaries (operators, starters, etc) (Enter on Line 20 GSA form 1217)
24. Small tools and expendable supplies
25. Labor (includes contracted work)
26. Subtotal Elevators (Add Lines 24 and 25. Enter result here and on Line 21 GSA form 1217)
G. Miscellaneous
26. Building Engineer/Manager (Enter on Line 22 GSA form 1217)
27. Security (Watchmen, Guards) (Enter on Line 23 GSA form 1217)
28. Social Security Tax and Workmen's Compensation Insurance (Enter on Line 24 GSA form
1217)
29. Landscape and Grounds (materials, fertilizers, supplies)
30. L/S and Grounds Labor (includes contracted work)
31. Lawn and Landscaping (Add Line 30 and 31. Enter result here and on Line 25 GSA form 1217)
32. Other (Explain on separate sheet. Include Schedule B Special Requirement Items) (Enter amount
here and on Line 26 GSA form 1217)
33. Subtotal Annual Operating Expenses
Part II Schedule A Page 4 of 9
Lessor __________ Gov't. __________
__________ of __________ Pages
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