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40 <br />C> <br />4W <br />Exhibit C <br />FORM OF REQUISITION REQUEST <br />FOR IMPROVEMENT + COSTS <br />REQUISITION REQUEST NO. <br />LATE: <br />TOTAL DISBURSEMENT REQUESTED-, <br />REFERENCE. Development Agreement dated as of September I, 2000 (the "Development <br />Agreement"), between Los Angeles Dodgers, Inc. ("Dodgers"), and <br />Indian River County, Florida ("County") <br />The County Clerk is hereby requested to disburse from the Construction Fund established by the <br />County to the person, firm or corporation designated below as Payee, the sum set forth below such <br />designation, in payment of the cost of those items of the Improvements constructed or installed pursuant <br />to the Development Agreement. <br />1, The undersigned, on behalf of the Dodgers, hereby requests the County to direct and instruct the <br />County Clerk to pay the amounts in accordance with the invoices attached as Exhibit A, and certifies in <br />connection with such direction that: <br />t a 1 The Improvement described on Exhibit "A" hereto has been constructed or installed at the <br />Facility and the construction or installation of such Improvement has been completed on <br />or before the date hereof, <br />(b) The Dodgers have conducted such inspection and+or testing of the Improvement as they <br />deem necessary and appropriate, and have accepted the Improvement; and <br />t c 1 The Improvement described on Exhibit "A" hereto is covered against all risks pirrsuarit to <br />die policy of insurance required by the Facility Lease Agreement dated as of September <br />1, 2000 between the County and the Dodgers, <br />2. In the event that the Dodgers are to be reimbursed for invoices previously paid by the Dodgers for <br />such items, written evidence of such prior payment and the amount thereof is also attached to this <br />Requisition, <br />3. Attached hereto are the following (check each item attached), each of which is true and correct <br />C1 <br />WA <br />