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U-1 <br />40 <br />in all material respects: <br />{_ } A true copy of the applicable purchase order and, where applicable, a duplicate original <br />of any change order approved by the Dodgers increasing the costs of the hnprovements <br />in an amount in excess of the original price therefor, <br />(_) Bills of sale for any component of the Improvements for which a bill of sale maybe <br />delivered; and/or <br />(—) A true copy of the Payee's statement or invoice. <br />4. Please disburse the following amount to the following Payee (if more than one Payee, please attach <br />additional pages hereto setting Forth the following information): <br />Amount: <br />Address: <br />Invoice No.: <br />S. To induce the County to approve this Requisition and authorize the County Clerk to disburse funds <br />held in the Construction Fund, the undersigned certifies that there are no outstanding construction liens <br />a¢ainst the Facility. <br />6, The following constitutes an itemized list of attachments to this certificate, if applicable: <br />(a) Contractor's Application for Payment (AIA Foams G702 and 0703). <br />(b) Architect's Certificate (AIA Forms G702 and G703). <br />C-2 <br />