HomeMy WebLinkAboutDepartment of Human Resources
Augusta Richmond GA
DOCUMENT NAME: d~. tR m\f'Ofl X-6tlJ'(Cf.S .
DOCUMENT TYPE:
YEAR: 0\
BOX NUMBER: \ L\
FILE NUMBER: \ 5 1 dL\
NUMBER OF PAGES: lJ2
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Department of Human Resources Space Request
[1] Type of Request'
New 0 Renewal ~,
(New Program)
Renegotiation 0
Relocation 0
Other, 0
(TAW, etc.)
[21 Current Rental
Agreement Number,
Amendment 0
(~bange Terms of Lease:
Decrease Sq Ft, Options,
Utilities / Janitorial)
Modification to Space 0
(One-Time / Special Rent Assessment)
Addendum 0
(Increase Sq Ft)
Cancellation 0
(Cancel Program)
Fiscal Year
(For This Year)
Division/Office
MIL 0
Regular Lease 0
Memorandum of Agreement 0
Other 0
(Current)
(Needed)
[31 Fun Time Total
# Budgeted Positions: 284.50 Positions
# Additional Positions:
Part Time
# Part Time Positions:
(ci'iyicounty)
(O"c~~pancy Date)
Square Feet:
[41 Rental Information .
(5) Type Site Locale
Office Park 0
House 0
Mall 0
Building 50
Other 0
CurreDt Address: _-.:::-. - -_
(6) Current Building ProblemslUnresolved ADA IS!lues
Relocation:
Landlord Notified iD Writing? Yes 0
No 0
Local Contact
(7) Reason for ReqiJestIRemarks (Division/Office Space Coordinator)
Name:___~~rolyn, Beard
City: u!:\fgusta
(706) ,
Phone #: 7.21-2536 FaX#: 721-7140
Lease Period
(8) TYpe ofProgram(s) at This LocatioD (Public Health Only)
Monthly ReDt: $96,676
Monthly Utilities. :
Monthly Janitorial. :
Monthly Total:
'Ifnot included in rent
(9) Subl~ase InformatioD
A) Our Division, (the Subiessee), is Currently RENTING _ Sq Ft, from the Division of___.
OR
B) Our D~vision is the Primary Lease & Currently has a TOTAL OF --.: Sq Ft I
As the Sublessor, the following DIvisions are Subleasing space from us, Write do'!,.n EACI!..DivisioD &
the TOTALSq Ft They Sublease: APP~iChlED
From:
To:
:IV~ &l7?l"~~
, ,tC&('IYC~ ~1
/JMcS
/MY 6 ", jl)~t
[101 DHR Budget CoordiDator: I certify tbat the actioDrequested is necessary for tbe proper functloD
of tbe agency Damed and tbat sufficieDt funds are available iD tbe % amouDts of tbe followiDg:
s
% are FEDERAL FUNDS;
% are STATE FUNDS;
% are COUNTY FUNDS;
% are OTHER
DHR Budget Coordinator Name
Review and Approvals
Division/Office
Room-Building
SigDature
Signature
Date
Date
DivisioD Leasing CoordiDator
Division/Office Director
. For Addendum (AddltJon.. sqft), New Progr.m, or Reloallon
Office of Facili~ and Support Services - LeasiDg Specialist
Office of Facility aDd Support Services - Director
REV. il/812000 S:\Leasing\Forrns\Space Request
Instructions: Submit Original, Plus (1) Copy and Attachments
Assigned To:
, 'r Louis BC,wen - MIL Form.doc
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Page 1
Lease #
Georgia Department of Human Resources
Division of Family and Children Services
FY
LOCAL STATEMENT OF SERVICE AND MAINTENA~CE COSTS
IN LIEU OF RENT IN PUBLIC BUILDINGS
OR
THIRD PARTY LEASING ARRAL'\TGEMENT
PREPARE
rN
QUADRUPLICATE
OFFICE OF THE
City of LaGrange
Richmond
COUNTY
August;:)
GEORGIA
TO: Georgia Department of Human Resources/Richmond COllnty DFr.S
For third party space or service and maintenance costs in providing you agency with 'office space in the public facility building
know as the Georgia Department of Human Resources,
building, located at
520 Fenwick Street
Augusta
77,159
Georgia.
Square Feet@ 15.0353 Per Square Foot per Annum'
1.160.108
96,676
Monthly Charge (Charge per Annum Divided by 12)
THIS MONTH!.. Y CHARGE, in lieu of rent or for third party lease payment, is to remain constant for a minimum period of
twelve (12) months from date of acceptance by the local HUman Resources program, and the basis on which it is computed is shown on the
reverse side herein.
This monthly charge has been determined solely for the purpose of obtaining State and Federal Participation in costs incurred by
County/City fiscal authorities in providing office space for a Human Resources program. It is un4erstood that acceptance by the Georgia
Department of Human Resources is subject to review and audit by the Internal Audit Unit, and the County/City fiscal records form which
such costs have been determined will be open for their inspection. The audit may be either State or Federal (or both).
I DECLARE THAT the information furnished herein to the best of my kno
complete.
D,Ie . 77h.t ( .:JctJI cf
(AFTER EXECUTION, COUNTY FISCAL AUTHORITY WILL TRANSMIT IN TRIPLICATE TO DIRECTOR)
ACCEPTANCE
Date
Commissioner, DHR.
PA YMENTS against this agreement are to be made to:
\\OHR._2PTO 16\ VaLl \OAT A\USERSIADMIN\OTS\CGKll.G-1 \OOCUMEN1\LEASE\MIL Form.docFORM 746, (3-84)
FORM 746 (3-84) Page I of 4
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tlf.uis 86~n - MIL Form.doc
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Schedule in support of Third Party Space OR Service and Maintenance Costs in Lieu of Rent in Public Buildings
SCHEDULE A - SERVICE AND MAINTENANCE EXPENSES,
For the County Fiscal Year Ended
. TABLE I - ELEMENTS OF EXPENSE Applicable To All Applicable To Human
Occupants of Building Resource Program Only
Heat 2': 2'}5
Lights 8Q.Q'iO
Waler .1.821
Custodian Service 34 hQ1
Janitor and Maid Service 'i7 1QR
Elevator Service
Cleaning Supplies and Contracts 67.0hR
Painting and Decorating .
Maintenance Repairs: .
Repairs and Repair Parts: .
Electrical h h?l
Plumbing imd
Heating
Elevators 1 ,QOR
Building, General 6. R7R
Maintenance Repair and Engineering Service . 3,490
Upkeep of GroundS
Insurance 2 1hO
Depreciation (From Table 2)
Hand rools and Minor Maintenance Equipment
Other Expenses (Specify) 451R7
.Third Party Lease Agreement . 840.477
Total Expense 1',160,108
Total Square Footage of Building 77.159 sq. ft.
Annual Cost per Square Foot
(Divide Total Expenses by Total Square Footage) 15.0353
Square Footage Occupied by Human Resource Program 71.,159 sq. ft.
Pro-rata Annual Cost to Human Resource Program sq. ft.
(Square Feet Occupied by Annual Cost per Square Foot)
TOTAL ANNUAL CHARGE TO HUMAN RESOURCE PROGRAM
(Add (A) and
(B))
ANNUAL CHARGE PER SOUARE FOOT TO HUMAN RESOURCE PROGRAM
(Divide Total Annual Charge by Square Feet Occupi~d)
1,160,108
.1
15.0353
TABLE 2 - EXPLANATION FOR DEPRECIATION CLAIMED IN TABLE I
Type Construction of Date Estimated Life Cost Depreciation in Remaining Cost Depreciation this Depreciation
Building Acquire to be used in (exclusive of land) Prior Yean Beginning of Year Rate
d Accumulating, Year
Depreciation'
1. Masonry, Solid SO 2%
2. Masonry, Frame 33 1/3 3%
3. Frame 2S . 4%
Additions: (if any)
4.
\\DHR_2PTO 16\ VOL I \DA T A\USERS\ADMIN\OTS\CGKlLG-1 \DOCUMEN1\LEASE\MIL Form.docFORM 746 (3-84)
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A)
B)
H.ouis S-Qwefl - MIL Form.doc
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TOTAL (Enter as Depreciation Expense, above, under Table I)
Classify building as to type of construction as indicated' above, lines I thru 3. Additions if any, lines 4 and 5. Use appropriate
depreciation rate. See page 4 for detailed instructions.
Schedule in support of Third Party Space OR Service and Maintenance Costs in Lieu of Rent in Public Buildings
SCHEDULE A - SERVICE AND MAINTENANCE EXPENSES (CONTINUED)
TABLE 3 - BUILDING DESCRIPTION
Department of Human Resources
Name and Location of Building 520 Fenwick Street
General Description of Building (Attach sketch of space occupied.)
(Type andma1erial of construction, etc.) 'original single story brick building and a
three (3) story dryit ad;oining"building
General Condition
good
Age
11
Yrs.
Dimensions of Building: Length
Square Foomge of Building
(Net usable space) 77 , 159
ft.
Width
ft. No. of Floors
Average Square Footage per Floor
(Net usable space)
Location in building of Human Resource Program(s)
Human Resources Program occupies the entire bldg.
Number of Rooms Occupied by Human Resources Program All
Total Square Footage Occupied
77 ,159
Facilities Furnished to the Human Resource program (See Instructions) Fire insurance, j ani tor and maid
service, utilities, Building superintendent, security services, security
guards (2), building maintenance and parking.
FUNDING OUT CLAUSE
Notwithstanding any other provision of this agreement, the parties hereto agree that the rent hereunder is payable by the Lessee solely
from apprOpriatiOrls received by the Lessee from the General Assembly of the State of Georgia. In the event such appropriations are
determined, in the sole discretion of the chief operating officer of the Lessee, no longer to exist or to be insufficient with respect to the rent
payable hereunder, this agreement shall terminate without 'further obligation of the Lessee as of that moment (hereinafter referred to as
"Event"). In such Event, the chief operating officer of the Lessee shall certify to the Landlord the occurrence thereof, and such certification
shall be conclusive.
INSTRUCTIONS FOR LOCAL s1' A TEMENT OF SERVICE AND MAINTENANCE COSTS
GENERAL INSTRUCTIONS
These instructions ~ tn explain the purpose of, and describe requirem'cots in the preparation of Form 746, Local Statement of Service and Maintenance
Costs in Lieu of Rent in Public Buildings OR Third Party Leasing Arrangements.
Purpose of Forma
Acceptance-Effective Date
The purpose of this form is to provide for State and Federal participation
in those costs incurred and paid directly by the county/city fiscal authorities
for operation and maintaining a public building in which a Human
Resoun:c program occupies space.
Proposals for Federal matching of service and maintcoance costs become
effective with the month in which they ~ accepted by the local Human
Resoun:e program. '
\\DHR_2PTO 16\ VOL 1 \DA T A\USERS\ADMlNIOTS\CGKlLG-l \DOCUMEN1\LEASE\MIL Form.docFORM 746 (3-84)
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~J.Gu.is Bl?,wen - MIL Form.doc
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Prepared by Whom
This form is to be prepared, in quadruplicate, in the office. of the
county/city fiscal authority. Certificate of countyfcity official preparing, or
furnishing information for preparation of Schedule A. Tables 1,2 and 3, from
which monthly charge for space is determined, is required on page 3.
Propasal for claiming Federal participation in the manthly charge so
. determined is made over the signature of the county/city fiscal authority in
space pravided on page I. Where fiscal autharity is vested in a Baard of
Commissianers, the signature shall be that of the Chairman.
Basis for Charges
, Charges far office space under this palicy provision will be allowed an
the basis of a uniform monthly per square foot charge, with a unit cast based
on the tatal .of such expenses paid directly by the county fiscal autharities far
the preceding countyfcity fiscal year, but in no instance to exceed the cost
that wauld be reQuired for occupancy of comparable space in a private
building. The monthly per square foot charge, after establishment and
acceptance by the local Human Resource program, must remain constant far
a minimum of twelve months. Revisians, either upward or dawn ward, may
be negotiated after the expiratian .of thi~ required term.
Please remember that dacumentation for charges shawn on Tables I, 2
and 3 .of the Local Statement .of Service and Maintenance Casts will be the
responsibility of the local countyfcity fiscal authority. The Georgia
Department of Human Resaurces assumes no Iiahility for audit exceptions.
PREPARARTION OF SCHEDULE A
TABLE i-ELEMENTS OF EXPENSE
The following instructians describe the classes of expenditures which may he claimed as Service and Maintenance Casts. These expenditures may be
pro-rated to all occupants of the building, .or joint costs may be prorated and expenditures for the exclusive benefits of the human resoUrce program charged
direct in the calumn provided. If di=t charges are made to the human resaurce pragram, expenditures for the exclusive benefit of other .occupants are to be
excluded from proration. '
Painting and Decorating, Maintenance Repain, and Upkeep of Grounds included herein are routine .or ordinary, nat materially prolonging the life, or
increasing the value of the property.
Items .or services purchased in large quantities, for several or all buildings of a countyfcity, may be prorated among buildings, on a basis of reasonable
appraximation by the use oca common unit of measure. For any and all such items, warking papers, memarandums, or other data used in compiling costs
should be held for examinatian by State and Federal auditon.
Do not cla,im in this statement, any expenditures form the bank accaunt of the human resource program.
HEAT, LIGHT, WATER: Included costs of-providing heat, lights, and
water, whether purchased, or furnished by a caunty organization.
CUSTODIAN, JANITOR AND MAID, ELEVATOR SERVICE: Include
services of buildiitg superintendent, custadian, watchmen, janiton, porten,
maids, elevator operaton, etc. Maintenance and grounds personnel are
included in another category.
CLEANING SUPPLIES AND CONTRACTS: Include costs of articles and
praducts used in keeping building and equipment in sanitary and efficient
canditian. Also building cleaning .or. service can tracts, such as window
cleaning service, towel service, etc.
PAINTING AND DECORATING: Include cost of painting building
interior, floor ..eflDishing, plastering, papering, etc. Also, include services
.of painter, plaSterer, etc. Do nat include painting or otherwi.so refinishing
entire exteriar of building, or decorating projects that materially prolang the
life .or increase the value of the building.
MAINTENANCE REPAIRS AND REPAIR PARTS: Include by category,
minor or ordinary repain by outside agencies, and repair material or parts
used by regular maintenance emplayees in making routine repain.
MAINTENANCE REPAIRS ANDENGINEERING SERVICE: Include
services of county emplayed maintenance and engineering employees (full
time, per diem, or hourly basis), such as building engineers, mechanics,
electricians, carpenters, etc.
Do not include under Maintenance Repairs, expenditures which materially
prolong the life, .or increase the value .of the building, or building
equipment, and therefore shauld be added to its cast and recovered by
annual depreciation or amortizatian allowances.
UPKEEP OF GROUNDS: Include services of gardeners, yardmen, etc., and
agricultural and botanical supplies used in upkeep of building grounds. Do
not include extensive grounds improvements or outlays which materially
enhance the property.
INSURANCE: Include premiums for insurance covering loss or damage .of
building or contents. Premiums paid in advance are ta be apportianed
annually, aver the life of the palicy on a straight time basis. Do nat include
public liability insurance.
HAND TOOLS AND MINOR MAINTENANCE EQUIPMENT: Include
expenditures for hand taols and minor items .of equipment used by
emplayees in the maintenance of the building and upkeep of the grounds,
such as, carpenter toals, plumbing toals, paint brushes, shean, rakes,
shovels, lawnmowers. hose, etc.
OTHER EXPENSES: Include expenditures relative to the service and
maintenance of the building, but not classified under preceding headings.
ORental reimbursement for private lease.' '
TOTAL SQUARE FOOTAGE: Include tenantable areas only, i.e., offices,
courtrooms, jwy roams, judges' chambers, etc. Do not include halls,
com don, stair wells, toilets, or other nan-tenantable areas.
TABLE 2- DEPRECIATION
.
Since these instructions relate to the measuring of depreciation, they may be disregarded by countiesfcities nat claiming dep=iatian, or whase
building are beyand the ages stated in Table 2.
I\OHR_2PTD I 61 VOL I\OA T AIUSERS\ADMIN\OTSICGKD...G--l\OOCUMEN1\LEASE\MIL Form.docFORM 746 (3-84)
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TYPE OF CONSTRUCTION: Classify building as to ~ of construction, COST: Show cost ofpurthase or constnlction of building. This cost to be
as follow:' exclusive of the cost of the land upon which the building stands. If land
cost is not known, a rellllOnablo estimate or appraisal will be aCcepted.
I. MASONRY, SOLID: Building of slow burning or fireproof construction - .
such as masonry, brick, concrete, concreto or cinder blocks, tile, brick DEPRECIATION IN PRIOR YEARS: Compute depreciation for prior
and steel, stee.I,frame, steel and stucco, etc. yeatll, i.e., from date of acquisition by county to current year, by use of
, . . appropriate =ual rate; and insert in this column.
I. MASONRY, FRAME: Buildings of the same exteriors as above, but with .
wooden frame interiors. REMAINING COST BEGINNING OF YEAR: Value of building after prior
yeatll depreciation is deducted from original cost.
3.
FRAME: Buildings of wooden frame or similar construction.
DEPRECIA nON TInS YEAR: Compute deprcciation for current year by
use of appropriate rate and insert in this column. Also, carry this amount to
Table I.
4-5. ADOmONS: Describe the addition to building. Give estimated useful
life. Apply appropriate depreciation rate, i.e., rate applicable to ~ of
construction, as given in Table 2.
TABLE 3 - BUILDING DESCRIPTION
Give name and location of Building: ''Newton County Courthouse, Covington, Georgia," or "Cobb County Office Building, Marietta, Georgia". Give
general description: "Two story red brick building:' Show general condition of repair as: Excellent, Good, Fair, Poor, Rundown, Shabby, etc. Give
measuremerilS of building ':.'ld square footage. Net usable space is gross square footage less non-tenantable areas, such as halls, toilets, etc. Give location
of human resource program: "N.W. Comer of second floor," and number of rooms and square footage occupied by that program. List facilities and services
furnished tho human resourc.e program: "Private toilct,janitor service, lights, heat, water," etc., whose costs are included in Table 1.
PREPARATION OF SCHEDULE B
This statement of comparable rent (Fonn 5465) is to cstablish the' fact that the charge to the human resource program for service and maintenance
costs is not in excess of CUlTent rent in the community, for comparable space, facilities and service in a private building. These tbrcc statements must be
from a disinterested qualified penon: realtor, building and loan association official, bank official, etc. It cannot be from a public official.
After "FROM," insert name of pm on making the statement. After "OF'" insert his addreu. Give his professional qualifications, such as, Member
. Real Estate Board: President, John Doe Reality Co., etc.
\\DHR_2PTO 16\ VOLI \DA T A\USERS\ADMlN\OTS\CGKILG-I \DOCUMEN1\LEASE\MIL Fonn.docFORM 746 (3-84)
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