Capital Claims Submittal Form

Revised 03/04/2013

California State University Capital Claims Submittal Form

Campus Name: [Campus] Enter the name of your campus. Project Name: [Project Name] Enter the project name for which this claim is being processed. We’ve provided a complete list of projects on page #2 of this document. Please copy and paste your project name into the field above.

GO Bond Fund-Subfund Number: [Fund Number] Enter the appropriate fund-subfund (listed below) number to the input box above

Claim/PFA Amount: [Claim Amount] Enter the claim amount in dollars above (include decimal: nnnn.nn).

E-Mail Address: [Contact Email] Enter the e-mail address of the person you would like to receive the “Cumulative Disbursements” certified letter for this fund.

Please save this document and e-mail to: [email protected]

Fund-Subfund Numbers 0574-302 October 2009 Tax Exempt 6041-327 September 2012 Tax Exempt 0574-317 March 2009 Tax Exempt, BL 09-09 6041-334 October 2011 Tax Exempt 0574-372 Build America Bonds, BL 09-15 6041-335 December 2010 Build America Bond 0785-306 October 2009 Tax Exempt 6041-372 Build America Bonds, BL 09-15 0658-306 April 2012 Tax Exempt 6041-382 October 2009 Build America Bonds 0658-325 October 2011 Tax Exempt 6048-304 October 2009 Tax Exempt 6028-301 October 2009 Tax Exempt 6048-306 September 2012 Tax Exempt 6028-311 March 2009 Tax Exempt, BL 09-09 6048-307 March 2010 Build America Bonds 6028-371 Build America Bonds, BL 09-15 6048-311 March 2009 Tax Exempt, BL 09-09 6041-303 March 2010 Build America Bonds 6048-312 October 2011 Tax Exempt 6041-308 March 2009 Tax Exempt, BL 09-09 6048-340 December 2010 Build America Bond 6041-312 October 2009 Tax Exempt 6048-372 Build America Bonds, BL 09-15 6041-316 November 2009 Tax Exempt 6048-382 October 2009 Build America Bonds

Capital Claims Submittal Form Page 1 of 3 5/8/18 Revised 03/04/2013

Campus Projects List

Bakersfield - Electrical Transducer at Icardo Center Los Angeles - Administration, Seismic Upgrade

Bakersfield - Fire Alarm System Upgrade Los Angeles - Corporation Yard & Public Safety

Bakersfield - Math & Computer Science Building Los Angeles - Forensic Science Building

Chancellor's Office - Budget Office Los Angeles - Science Replacement Bldg. Wing B

Channel Islands - Classroom & Faculty Office Reno/Add Monterey Bay - Heating Energy Efficiency Upgrades

Channel Islands - Entrance Road Monterey Bay - Library Redesign

Channel Islands - Infrastructure Improvements Northridge - Campus Utility Infrastructure

Channel Islands - Solano Hall Bldg. Renewal/Roof Repair Northridge - Engineering Renovation Phase II

Channel Islands - Substation Northridge - Performing Arts Center

Channel Islands - West Hall-PW Northridge - Science I Replacement - Equipment

Chico - Taylor II Replacement Bldg-PW Pomona - College of Business Administration - E

Dominguez Hills - Educational Resource Ctr. Addition Pomona - Fire Alarm System Renewal, Ph. II

Dominguez Hills - Electrical Infrastructure, Phase II Sacramento - Capistrano Hall HVAC

Dominguez Hills - Minor Cap-Energy Incentive San Bernardino - Access Compliance Barrier Removal

Dominguez Hills - Nursing Facility Improvements San Bernardino - College of Education

Dominguez Hills - Water Line Renewal - Campuswide San Diego - Storm/Nasatir Halls Renovation

Dominguez Hills - Water Line Sliplining, Phase II San Francisco - Joint Library: JPL and Sutro (2010/11)

Dominguez Hills - Welch Hall & Extended Ed MBCx San Francisco - Joint Library: JPL and Sutro (2011/12)

East Bay - Electrical Infrastructure Renewal, Phase I Campuswide San Francisco - Nursing Facility Improvements

East Bay - Electrical Infrastructure Renewal, Phase II San Francisco - School of the Arts/Font Street Property

East Bay - Nursing Facility Improvements San Jose - Spartan Complex Renovation-PW

East Bay - Plumbing System Upgrade, Meiklejohn Hall San Luis Obispo - Crandell Gymnasium (Seismic)

East Bay - Student Services Replacement Building San Luis Obispo - MBCx Express - Infrastructure Upgrade

Fresno - Faculty Office/Lab Bldg-PW San Marcos - ADA Compliance

Capital Claims Submittal Form Page 2 of 3 5/8/18 Revised 03/04/2013

Humboldt - Behavioral & Social Sciences, Phase I San Marcos - Social & Behavioral Science Bldg - E

Humboldt - MBCx - 2008 Energy Projects San Marcos - Social & Behavioral Science Bldg - WC

Humboldt - West and East Gym HVAC/Electrical San Marcos - Social & Behavioral Science Building - C

Humboldt - West Gym Office Renovation Sonoma - Mechanical and Lighting Renewal

Long Beach - Liberal Arts Replacement Stanislaus - Science II (Seismic)

Long Beach - Library Addition and Renovation Stanislaus - Stockton University Park Nursing

Long Beach - Peterson Hall 3 Replacement Systemwide - Office of the Statewide Audit

Long Beach - Tennis Court Repairs & Replace Relay Control Syst. Systemwide - Working Capital

Capital Claims Submittal Form Page 3 of 3 5/8/18