Section: 440-3 Exhibit D
Effective: 4/1/98
Supersedes:
Issuing Office: Real Estate Development (RED)

SAN DIEGO CAMPUS

ROUTING DATE:

Administrative Information

Real Estate System # _____ Type Agreement: _____ Type Action: _____

Approval Level: Campus _____ OP _____ Regents _____ Source: _____

Org./Index: ______________________Fund: ______________________

Lease Participants

Department: _________________________________Lessor:____________________

Phone: _______________________________________________________________

Address: _____________________________________________________________

Property Information

Address: ______________________ RSF/Lease: _________ Year Bldg. Constructed:

Total Bldg. Sq. Ft: _________________Lease Space Usage: __________________

Total SF Occupied by University: ___________________________

Lease Information - Terms

Start Date: _________ Term Date: _________ Length of Term ____yrs.____ mos.____ days

Options: _________________________________Type of Lease: ___________________________

Lease Information - Financial

Initial Monthly Rent: _____ Cost Per Sq. Ft.: ________ Utilities/Services Included? Yes _____ NO _____

Tenant Improvements: Pd. by Tenant: _____ Pd. by Landlord: ______ Total TI Amt Paid by Landlord Yes ____ No ____

First Year Rent (exclude consessions): _______ Consession: _____ Adjustment Method: ______

Total Minimum Cost Over Term: ____________________ Minimum % Increase: ________

Total Maximum Cost Over Term(include CPI max): __________Maximum % Increase

APPROVALS:

____________________________________________________________
Lease Initiator/Date

____________________________________________________________
Department Chair/Date

____________________________________________________________
Dean, School of Medicine/Director, Hospitals & Clinics / Date