Common use of YES NO Clause in Contracts

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Service Department Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxx/Roadway Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2651% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Xxxxxx Xxxxxxxx, P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 260% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx/Engineer Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxx Xxxxxx/Engineer Asst. Dir. of Public Services / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxxxx Xxxxxx Xxxxxxx/Engineer Mayor / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2684% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2663% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxx/Engineer Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2631% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2630% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxx Xxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2646% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxx/Engineer Trustee / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2636% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx/Engineer Road Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2625% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/, P.E./Sanitary Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2652% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxx/Chief Deputy Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxx Xxxxxx/Engineer , P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2693% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxx X. Xxxxxx/Chief Deputy Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2627% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxx Xxxxxx/Engineer , P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2664% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2655% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxx/City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2625% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxx/Civil Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxXXxxx/Engineer Water Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2691% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx/Engineer Street Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxx/Engineer Township Trustee / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2680% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxx/Engineer Project Coordinator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Public Works Dir. / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Engineer Safety-Service Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Xxxxxx X. Xxxxx, Xx., P.E., P.S./Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2651% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Director of Public Service / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2641% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2661% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Engineer Community Development Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2666% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2660% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxx Xxxxxx/Engineer Project Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2636% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxxx/Engineer Township Trustee / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxxxxx/Engineer Construction Section Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2658% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Safety Service Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxIwanacjek/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2665% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2621% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Xxxxx Xxxxxxxxxxxx, P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2680% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Design Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2611% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx Xxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2638% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Village Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2660% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2655% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx/Engineer Deputy Service Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxxx Xxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxDon Schvegzda/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2625% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2643% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx/Engineer Service Director / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2656% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxx Xxxxxx/City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Xxxxxxx, P.E./City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2687% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxxxxx/Project Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxx Xxxxxx/Engineer , P.E., P.S./Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Township Trustee / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2687% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2646% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx/Engineer Road Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Xxx Xxxxx, P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2649% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Born/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2660% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxxxxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 260% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Engineer Pres., Board of Trustees / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxx/Engineer President of Council / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2653% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx XxXxxxxxx/Engineer District Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2674% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxxxx/Engineer Wastewater Supt. / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2617% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2686% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx Xxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC OSGCIC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2689% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxx Xxxxxxxxx/Project Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 260% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxxxx/Engineer City Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxxxxx/City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2634% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2630% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2662% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxxxxxxxx, PE/Engineer Director of Water / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 26% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxxxx, PE/Engineer Service Dir. / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2611% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxxxx/Engineer Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2666% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Design Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2676% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxx/Engineer Director of Public Works / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxxxx/Engineer Water/Sewer Superintendent / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2692% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer / / Date ( ) - Phone.

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2648% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Engineer Xxxxx Xxxx, P.E./Project Manger / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2610% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2651% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxxx Xxxx Xxxxxx/III, P.E./Sanitary Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxx Xxxxxx/Engineer , P.E./Project Manager / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2627% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2629% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxxx Xxxxxxx/City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2641% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx/Xxxxx Xxxxxxx, P.E./City Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2629% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx Xxxxxx Xxxxxx/Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2631% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx Xxxxx/Engineer Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2650% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxx/Engineer Village Administrator / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2631% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxxxx, PE/Project Engineer / / Date ( ) - Phone

YES NO. If the answer is YES or if this disbursement uses the remainder of your OPWC assistance, your project file will be closed upon processing this request. As described in Appendix D of the Project Agreement, your minimum Percentage Contribution is 2651% of the total project cost. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AUTHORIZED CERTIFICATIONS All signatures must be original and in color ink. (Note: Changes to project officials must be submitted in writing.) PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Xxxx XxxxxxXxx Xxxxxxxx/City Engineer / / Date ( ) - Phone