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40 <br />i <br />2. In the event that the Dodgers are to be reimbursed for invoices previously paid by the <br />Dodgers for such items, written evidence of such prior ,payment and the amount thereof is <br />also attached to this Requisition Request. <br />3. Attached hereto are the following (check each item attached), each of which is true and <br />correct in all respects: <br />U) A true copy of the applicable purchase order for the repair or replacement; <br />(� Bills of sale for any component of the repair or replacement for which a bill of <br />sale may be 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, <br />please attach additional pages hereto setting forth the following information): <br />Payee: <br />Amount: <br />Address: <br />Invoice No.: <br />S. To induce the County to approve this Requisition and authorize the Capital Reserve <br />Account Agent to disburse fiends held in the Capital Reserve Account, the undersigned <br />certifies that there are no outstanding construction liens against the Facility. <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-6 <br />