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0 <br />• <br />i <br />WNI <br />3. Attached hereto are the following (check each item attached), each of which is true and <br />j correct in all material respects: <br />(�} A true copy of the applicable purchase order and, where applicable, a duplicate <br />original of any change order approved by the Dodgers increasing the costs of the <br />Improvements in an amount in excess of the original price therefor; <br />(� Bills of sale for any compo:tent of the Improvements for which a bill of sale may be <br />delivered; and/or <br />A true copy of the Payee's statement or invoice. <br />I <br />4, please disburse the following amount to the following Payee (if more than one Payee, please <br />attach additional pages hereto setting Forth the following information): <br />V <br />Payee: <br />d <br />i Amount: <br />Address: <br />d <br />Invoice No.; <br />I <br />S. To induce the County to approve this Requisition and authorize the County Clerk to disburse <br />funds held in the Construction Fund, the undersigned certifies that there are no outstanding <br />construction liens against the Facility. <br />t <br />G. The following constitutes an itemized list of attachments to this certificate, if applicable'. <br />(a) Contractor's Application for Payment (AIA Forms G702 and 0703). <br />(b) Architect's Certificate (AIA Forms G702 and G703). <br />�. C_2 <br />4 <br />