REPORT OF PROPOSED DEBT ISSUANCE For Office Use Only California Debt and Investment Advisory Commission 915 Capitol Mall, Room 400, Sacramento, CA 95814 P.O. Box 942809, Sacramento, CA 94209-0001 Tel.: (916) 653-3269 FAX: (916) 654-7440 CDIAC NO.: _____________ Completion and timely submittal of this form to the California Debt and Investment Advisory Commission (CDIAC) at the above address will assure your compliance with existing California State law and will assist in the maintenance of a complete database of public debt in California. Thank you for your cooperation.1 ISSUER NAME: ISSUE NAME: Please specify type/name of project: PROPOSED SALE DATE: PRINCIPAL TO BE SOLD: $ WILL A VALIDATION ACTION BE PURSUED: No Yes Unknown IS ANY PORTION OF THE DEBT FOR REFUNDING?2  No  Yes, proposed amount for refunding $ ____________________________________________ Issuer Contact: Name: _____________________________________________________ Email: ____________________________________________________ Title: Address: Phone: Issuer Located In County Filing Contact: Name of Individual (representing:  Bond Counsel,  Issuer,  Financial Advisor, or  Lead Underwriter) who completed this form and may be contacted for information: Name: Firm/Agency: Address: Phone: E-mail: E-mail: Send acknowledgement/copies to: FINANCING PARTIPANTS: BOND COUNSEL: FINANCIAL ADVISOR: UNDERWRITER\PURCHASER: IS THE INTEREST ON THE DEBT EXEMPT FROM TAXATION? Under State law: Under Federal law: TYPE OF SALE:   NO (taxable) NO (taxable)  Competitive  Negotiated IS THIS FINANCING A PRIVATE PLACEMENT?   YES (tax-exempt) YES (tax-exempt) If the issue is federally tax-exempt, is interest a specific preference item for the purpose of alternative minimum tax?   No Yes, preference item  No, not a preference item  Yes 1 Section 8855(g) of the California Government Code requires the issuer of any proposed new public debt issue to give written notice of the proposed sale to the CDIAC no later than 30 days prior to the sale. Under California Government Code Section 8855(i), “The issuer of any new public debt issue shall, not later than 45 days after the signing of the bond purchase contract in a negotiated or private financing, or after the acceptance of a bid in a competitive offering, submit a report of final sale and official statement to the commission. The Commission may require information to be submitted in the report of final sale that is considered appropriate. “ 2 Section 53583(c)(2)(B) of the California Government Code requires that any local agency selling refunding bonds at private sale or on a negotiated basis shall send a written statement, within two weeks after the bonds are sold, to the CDIAC explaining the reasons why the local agency determined to sell the bonds at private sale or on a negotiated basis instead of at public sale. CDIAC Proposed Form 7/10/2012 American LegalNet, Inc. www.FormsWorkFlow.com CDIAC: Report of Proposed Debt Issuance TYPE OF DEBT INSTRUMENT NOTE  Bond anticipation (BAN)  Grant obligation (GAN)  Other note (Please specify below.) (OTHN)  Revenue anticipation (RAN)  Tax allocation (TALN)  Tax and revenue anticipation (TRAN)  Tax anticipation (TAN)    Commercial paper (CP) Certificates of participation/leases (COPL) Other (Please specify below.) (OTH) Page 2 BOND  Conduit revenue (Private obligor) (CRB)  General obligation (GOB)  Limited tax obligation (LTOB)  Other bond (Please specify below.) (OTHB)  Public lease revenue (PLRB)  Revenue (Pool) (RB)  Revenue (Public enterprise) (PERB)  Sales tax revenue (STRB)  Special assessment (SAB)  Tax allocation (TAB) Please specify if "Other note/Other bond/Other" was checked: SOURCE(S) OF REPAYMENT  Bond proceeds (BDPR)  General fund of issuing jurisdiction (GNFD)  Grants (GRNT)  Intergovernmental transfers other than grants (ITGV)  Local obligations (LOB)  Private obligor payments (POP)  Other (Please specify.) (OTHS): Property tax revenues (PRTX) Public enterprise revenues (PER) Sales tax revenues (SATR) Special assessments (SA) Special tax revenues (SPTR) Tax-increment (TI) PURPOSE(S) OF FINANCING    Cash flow, interim financing (CFIF) Project, interim financing (PIF)    College/university housing (CUH) Multifamily housing (MFH)3 Single-family housing (SFH)3    Health care facilities (HCF) Hospital (HOSP) Other/multiple health care purposes (equipment; etc.)(OMHC)     College/university facility (CUF) K-12 school facility (KSCH) Other/multiple education uses (equipment, etc.)(OMED) Student loans (SLC)  Redevelopment, multiple uses (RD)    Commercial development (CMDV) Industrial development (INDV) Pollution control (PC)                     Airport (APRT) Bridges and highways (BRHI) Convention center (CCTR) Equipment (EQUP) Flood control/storm drainage (FLDS) Multiple capital improvements and public works (MCAP) Other capital improvements and public works (OCAP) Parking (PRKG) Parks/open space (PRKO) Ports and marinas (PRTS) Power generation/transmission (PWR) Prisons/jails/correctional facilities (PRSN) Public building (PB) Public transit (PTR) Recreation and sports facilities (RCSP) Seismic safety improvements/repair (SSI) Solid waste recovery facilities (SWST) Street construction and improvements (SCI) Wastewater collection and treatment (WSTW) Water supply/storage/distribution (WTR)   Insurance/pension funds (IPF) Other than listed above (OTH) Please Specify type/name of project: 3 Certain local government issuers of housing bonds are required to obtain a certification from the State Treasurer attesting to their compliance with the State housing reporting requirements prior to issuance of the bonds to finance single- or multifamily housing. CDIAC Proposed Form 7/10/12 American LegalNet, Inc. www.FormsWorkFlow.com