HomeMy WebLinkAboutExhibit 6Office of Capital improvements
Request tot AAivance'Pay,ment
Date
Grantee
Grantee Vendor Number
(FeaerallG Number)
Bond Series 1 Other
GOB Project Name & GOB Project Number
iGO8 Project Amount
Amount of Advance Requested
t Reason' For Requested Amount
1
1
€X11$B1T18
Certification
I hereby certify that this request is in compliance with the Office of Capital Improvements Building Fetter Communities
41 Bond Program Administrative Ruies, Adicie Ill Section 1C(8) governing the request for advance payments. 1 also
certify that this advance shall be maintained in a separlae interest bearing account, that these funds will not be,co-
mingled with other funds and that all interest earned will be repaid to the County I further agree to account 'tor this
advance within one (7) year of the approval dale, indicated below, and before any subsequent reimbursement requests
are submitted.
AUTHORIZED SIGNATURE
Administrative Use Only
Amount Approve°
j
DATE
Authorized Signature Date