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REQUISITION REQUEST NO. <br />DATE: <br />TOTAL DISBURSEMENT REQUESTED: $ <br />REFERENCE: Facility Lease Agreement dated as of December _, 2018 (the "Lease") <br />between Verotown, LLC, as lessee ("Verotown"), and Indian River <br />County, Florida, as lessor (the "County") <br />as the Capital Reserve Account Agent (the "Capital Reserve <br />Account Agent") is hereby requested to disburse from the Capital Reserve Account established <br />in the Lease to the person, firm or corporation designated below as Payee, the sum set forth <br />below such designation, in payment of the cost of the items of authorized capital improvements, <br />eligible maintenance, repairs or replacements pursuant to the Lease. <br />The undersigned, on behalf of Verotown, hereby directs and instructs the Capital Reserve <br />Account Agent to pay $ in accordance with the invoices attached hereto as Exhibit A, <br />and certifies in connection with such direction that: <br />(a) The items described on Exhibit "A" hereto represent authorized capital improvements, <br />eligible maintenance, repairs or replacements which have been constructed or installed at the <br />Facility and the construction or installation of such authorized capital improvements, eligible <br />maintenance, repairs or replacements has been completed on or before the date hereof, <br />(b) Verotown has conducted such inspection and/or testing of the authorized capital <br />improvements, eligible maintenance, repairs or replacements as they deem necessary and <br />appropriate and have accepted the same; and <br />(c) The authorized capital improvements, eligible maintenance, repairs or replacements <br />described on Exhibit "A" hereto are covered against all risks pursuant to the policy of insurance <br />required by the Lease. <br />In the event Verotown is to be reimbursed for invoices previously paid by Verotown for such <br />items, written evidence of such prior payment and the amount thereof is also attached to this <br />Requisition Request. <br />Attached hereto are the following (check each item attached), each of which is true and correct in <br />all respects: <br />(__) A true copy of the applicable purchase order; <br />(_) Bills of sale for any component of the capital improvements, maintenance, repair <br />or replacement for which a bill of sale may be delivered; and/or <br />(__) A true copy of the Payee's statement or invoice. <br />48 <br />