CPCM-Capital-Claims-Form by fanzhongqing

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									                                                                                                      Revised 3/20/2012


                                     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: claims@intranet.calstate.edu

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




Capital Claims Submittal Form                                  Page 1 of 5                                       5/16/2012
                                                                                          Revised 3/20/2012


                                               Campus Projects List
Bakersfield - 800-Ton Chiller Replacement                      Monterey Bay - Storm Water/Sewer Replacement, Upgrades

Bakersfield - Art Center and Satellite Plant                   Monterey Bay - Traffic Circulation Infrastructure

Bakersfield - Boiler Renewal                                   Northridge - Campus Utility Infrastructure

Bakersfield - Electrical Transducer at Icardo Center           Northridge - Engineering Renovation Phase II

Bakersfield - Fire Alarm System Upgrade                        Northridge - Fuel Cell Satellite Plant Improvements

Bakersfield - Math & Computer Science Building                 Northridge - Minor Cap-PWCE

Bakersfield - Nursing Renovation                               Northridge - Performing Arts Center

Chancellor's Office - Budget Office                            Northridge - Redwood Hall Mechanical System

Channel Islands - Classroom & Faculty Office Reno/Add          Northridge - Science I Replacement - Equipment

Channel Islands - Entrance Road                                Northridge - Science I Replacement - PWC

Channel Islands - Infrastructure Improvements                  Pomona - Central Plant Efficiency Retrofits

Channel Islands - John Spoor Broome Library                    Pomona - College of Business Administration - E

Channel Islands - Minor Cap-PWCE                               Pomona - College of Business Administration - WC

Channel Islands - Nursing Facility Improvements                Pomona - Fire Alarm System Renewal, Ph. II

Channel Islands - Solano Hall Bldg. Renewal/Roof Repair        Pomona - Library Addition and Renovation

Channel Islands - Substation                                   Pomona - Lower Water Reservoir Ren at NW Campus

Channel Islands - Telecom Renewal, Solano Hall Bldg Renewal    Pomona - Minor Cap-PWCE

Channel Islands - West Hall-PW                                 Pomona - Science Renovation (Seismic)

Chico - Chiller Replacement, Phase II                          Sacramento - Capistrano Hall HVAC

Chico - Meriam Library Lighting Retrofit                       Sacramento - Folsom Hall Health Services

Chico - Minor Cap-PWCE                                         Sacramento - HVAC/Electrical Renewal, Phase I

Chico - Roof Replacements-Butte Hall, Plumas Hall, etc.        Sacramento - Mechanical Ren. 1st Fl at Shasta Hall




 Capital Claims Submittal Form                            Page 2 of 5                                5/16/2012
                                                                                          Revised 3/20/2012


Chico - Student Services - Equipment                          Sacramento - Minor Cap-PWCE

Chico - Student Services - PWC                                San Bernardino - Access Compliance Barrier Removal

Chico - Taylor II Replacement Bldg-PW                         San Bernardino - Boiler Upgrade

Dominguez Hills - Educational Resource Ctr. Addition          San Bernardino - College of Education

Dominguez Hills - Electrical Infrastructure, Phase II         San Bernardino - EMS Upgrade

                                                              San Bernardino - HVAC/Electrical, Administration & Sierra,
Dominguez Hills - Minor Cap-Energy Incentive                  Science

Dominguez Hills - Minor Cap-PWCE                              San Bernardino - Mechanical Replacements - PE Building

Dominguez Hills - Nursing Facility Improvements               San Bernardino - Minor Cap-PWCE

Dominguez Hills - Water Line Renewal - Campuswide             San Bernardino - Nursing Facility Improvements

Dominguez Hills - Water Line Sliplining, Phase II             San Bernardino - Palm Desert Off-Campus, Phase III

Dominguez Hills - Welch Hall & Extended Ed MBCx               San Bernardino - Science Bldg Reno. & Addition, Phase II

East Bay - Electrical Infrastructure Renewal, Phase I         San Diego - Mechanical, Phase III at Love Library, HVAC Renewal
Campuswide                                                    Engineering

East Bay - Electrical Infrastructure Renewal, Phase II        San Diego - Minor Cap-PWCE

East Bay - Minor Cap-PWCE                                     San Diego - Social Science, Art Gallery, Parking Structure 8

East Bay - Nursing Facility Improvements                      San Diego - Storm/Nasatir Halls Renovation

East Bay - Plumbing System Upgrade, Meiklejohn Hall           San Diego - Telecommunications Infrastructure

East Bay - Student Services Replacement Building              San Diego - Water Efficiency Retrofit

                                                              San Francisco - Fire Alarm Ren at Thornton Hall, HVAC Renewal &
Fresno - Faculty Office/Lab Bldg-PW                           Roof Renewal

Fresno - HVAC Renewals 3 Buildings                            San Francisco - HVAC Renewal, Phase II

Fresno - Library Addition & Renovation                        San Francisco - Joint Library: JPL and Sutro (2010/11)

Fresno - Minor Cap-PWCE                                       San Francisco - Joint Library: JPL and Sutro (2011/12)

Fresno - North Gym Pool Replacement                           San Francisco - Minor Cap-PWCE




 Capital Claims Submittal Form                           Page 3 of 5                               5/16/2012
                                                                                               Revised 3/20/2012


Fresno - Nursing Facility Improvements                              San Francisco - Nursing Facility Improvements

Fullerton - College of Business and Economics                       San Francisco - Phase IV HVAC Controls Fine Arts

Fullerton - Dan Black Hall-Evap PreCool                             San Francisco - School of the Arts/Font Street Property

Fullerton - HVAC Improvements, Physical Education                   San Francisco - Telecommunications Infrastructure

Fullerton - HVAC Renewal in College of English & Visual Arts        San Jose - BC BT/IS Ceramics Lab Reno

Fullerton - Minor Cap-PWCE                                          San Jose - Computer Center HVAC Improvements

Fullerton - Nursing Facility Improvements                           San Jose - MBCx - Multiple Buildings

Humboldt - Behavioral & Social Sciences, Phase I                    San Jose - Minor Cap-PWCE

Humboldt - East Gyms Restrooms Remodel                              San Jose - Spartan Complex Renovation-PW

Humboldt - Forbes PE Complex Renovation                             San Jose - Stad/HVAC/Electrical Renewal

Humboldt - Mai Kai Land Acquisition                                 San Luis Obispo - Center for Science - P

Humboldt - MBCx - 2008 Energy Projects                              San Luis Obispo - Center for Science - W

Humboldt - Minor Cap-PWCE                                           San Luis Obispo - Engineering & Arch. Renov & Repl Ph II - E

Humboldt - Nursing Facility Improvements                            San Luis Obispo - Engineering & Arch. Renov & Repl Ph II - WC

Humboldt - Redwood Bowl Plaza Ped Access Improvements               San Luis Obispo - HVAC and Lighting Upgrades Ph. 1

Humboldt - Selective System Renewal in Nelson Hall                  San Luis Obispo - MBCx Express - Infrastructure Upgrade

Humboldt - Selective System Upgrades                                San Luis Obispo - Minor Cap-PWCE

Humboldt - West and East Gym HVAC/Electrical                        San Luis Obispo - Mott Pool Replacement

Humboldt - West Gym Office Renovation                               San Luis Obispo - Mustang Substation

Long Beach - Ed-1 AHU Replacement                                   San Marcos - Academic Hall II, Building 13

Long Beach - HVAC Replacement, Fine Arts #3                         San Marcos - ADA Compliance

Long Beach - Liberal Arts Replacement                               San Marcos - Craven Hall Renovation

Long Beach - Library Addition and Renovation                        San Marcos - MBCx - Multiple Buildings

Long Beach - Minor Cap-PWCE                                         San Marcos - Minor Cap-PWCE




 Capital Claims Submittal Form                                 Page 4 of 5                                 5/16/2012
                                                                                              Revised 3/20/2012


Long Beach - Nursing Facility Improvements                       San Marcos - Nursing Facility Improvements

Long Beach - Peterson Hall 3 Replacement                         San Marcos - Social & Behavioral Science Bldg - E

Long Beach - Tennis Court Repairs & Replace Relay Contol Syst.   San Marcos - Social & Behavioral Science Bldg - P

Los Angeles - Campuswide Roofing                                 San Marcos - Social & Behavioral Science Bldg - WC

Los Angeles - Corporation Yard & Public Safety                   San Marcos - Social & Behavioral Science Building - C

Los Angeles - Fine Arts Cooling Coil Replacement                 Sonoma - Chiller Replacement #2, Central Plant

Los Angeles - Fire Alarm & Sprinkler Repl. Phase 1               Sonoma - Green Music Center (E)

Los Angeles - Forensic Science Building                          Sonoma - Mechanical and Lighting Renewal

Los Angeles - Lighting/Elect/Elevator Replacement, HVAC          Sonoma - Minor Cap-PWCE

Los Angeles - Minor Cap-PWCE                                     Sonoma - Music/Faculty Office Building

Los Angeles - Science Replacement Bldg. Wing A                   Stanislaus - Air Handling Unit Replacement, Ph I

Los Angeles - Science Replacement Bldg. Wing B                   Stanislaus - Air Handling Unit Replacement, Ph II

Maritime Academy - Boiler Renewal/EMS/Roof Replacement           Stanislaus - Minor Cap-PWCE

Maritime Academy - EMS and Mechanical Controls Upgrade           Stanislaus - Science I Renovation (Seismic)

Maritime Academy - Fire Alarms                                   Stanislaus - Science II (Seismic)

Maritime Academy - Minor Cap-PWCE                                Stanislaus - Stockton University Park Nursing

Maritime Academy - Simulation Center                             Systemwide - Capital Renewal

Monterey Bay - Heating Energy Efficiency Upgrades                Systemwide - Facilities Renewal Resource Model

Monterey Bay - Infrastructure Improvements                       Systemwide - MBCx Express

Monterey Bay - Library - Equipment                               Systemwide - Minor Cap-PWCE

Monterey Bay - Library Redesign                                  Systemwide - Office of the Statewide Audit

Monterey Bay - Minor Cap-PWCE                                    Systemwide - Working Capital




 Capital Claims Submittal Form                             Page 5 of 5                                5/16/2012

								
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