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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇, P.E., P.S./Definace County Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇. ▇▇▇▇/Service Director ▇/Director of Public Service CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇, P.E./Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 31% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Village Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 10% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇▇/Underground Utilities Engineering CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director Department Superintendent CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 35% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Director ACDOES CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director Department Supervisor CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 15% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇▇/Civil Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 16% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 11% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 75% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director Department Superintendent CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 40% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 30% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 19% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Project Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 9% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇/Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director Dir. CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 10% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇/Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇, P.E./Principal, JMA Consultants CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 40% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇, Jr./Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service ▇▇▇▇/Public Works Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇/City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 41% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 35% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇▇▇/Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service /Utilities Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 5% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service ▇/Public Services Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Assistant Administrator of Operations CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service /Sewer Services Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/City Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Road Maintenance CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Grants Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 5% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 23% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 77% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service /Public Service Director CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 11% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 21% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 10% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 20% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 10% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇/Project Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 56% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director /Funding Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 51% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇, P.E./Vg. Engineer CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 % of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Director of Public Works CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 10% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 50% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇▇/Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 41% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director Skip Apple/Township Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 0% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 71% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇▇/Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 33% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇ ▇▇▇▇▇/Service Director ▇ Stuck/Village Administrator CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION:

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 16% of the total project cost. PROJECT MANAGER CERTIFICATION: ▇▇▇▇▇ ▇▇▇▇▇/Service Director /Project Manager CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION: