1. Entry Form

Instructions In an effort to streamline the submission process and reduce paper use, the submission process will be entirely electronic. Complete this form and the Project Form. Nomenclature for submission: Project Name-Project Form.ppt Create a zip file that includes the two completed forms and the project’s final GBCI scorecard. Email the zip file to 2016_Su.u47zgiazn0gv43b6@u.box.com Entry Form

A Project Name: Submitting Firm: Firm Role: Submitting Contact Name: Contact Address: Contact Phone: Contact Email: How did you hear about this award program: A Entry Form

B Entry Form Submission Category – Underline all that apply: Sustainable Sites Water Efficiency Energy & Atmosphere Materials & Resources Indoor Environmental Quality Innovation in Design Human Health & Wellbeing Excellence in Water Conservation (Optional – No additional Entry Fee Required) Project of the Year (Optional – No additional Entry Fee Required) Total Fees included with Submission: $______ ($125 per Category) Pay Online at www.usgbc-la.org Click on the “Donate” button in the upper right hand corner of the page to submit your entry fee(s) and add “Sustainable Innovation Awards” in the Comment box. Pay with check Payable to USGBC-Los Angeles Chapter. Mail checks to USGBC-LA, 800 Wilshire Blvd, 16th Floor, Los Angeles CA 90017 Attn: Ms. Dominique Hargreaves B Entry Form

C For LEED projects: LEED Certification Awarded - Month/Year: LEED Rating System: LEED Certification Level: For WELL projects: WELL Certification Awarded - Month/Year: WELL Building Typology: WELL Certification Level: C Entry Form

Project Team Members: Firm Name: Firm Role: Contact: Phone: Email: Add as many slides as needed for additional team members (Owner, architect, structural engineer, civil engineer, MEP engineer, landscape designer, LEED consultant, etc.) D Entry Form

D Project Team Members: Firm Name: Firm Role: Contact: Phone: Email: Entry Form

D Project Team Members: Firm Name: Firm Role: Contact: Phone: Email: Entry Form

D Project Team Members: Firm Name: Firm Role: Contact: Phone: Email: Entry Form