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Date <br />n <br />REQUEST FOR PROGRESS PAYMENT NUMBER: <br />NSP Grant Services Agreement <br />Townsend & Raitt, LP (Developer) <br />Project Address: <br />AMOUNT REQUESTED: <br />AMOUNT RETAINED: <br />AMOUNT DISBURSED: <br />PAYABLE TO: <br />Townsend & Raitt LP <br />V OFFICE USE ONLY o <br />SOURCE OF FUNDS AMOUNT <br />0 HOME <br />❑ CALHOME <br />❑ TAX INCREMENT <br />❑ CDBG <br />TOTAL DISBURSEMENT <br />IDS NUMBER: <br />ESCROW NUMBER: <br />ACCOUNT NUMBER / W.O.#: <br />DEVELOPER <br />The undersigned DEVELOPER: (1) Certifies that to the best of their knowledge, information and belief, the work summarized on the <br />attached project continuation sheet and covered by this Progress Payment Request has been completed in accordance with the NSP <br />Rental Development Agreement; (2) Certifies that they have obtained all required building permits, inspections and approvals for the <br />work covered by this Progress Payment Request. <br />Date <br />Print Name / Title <br />Signature <br />CITY OF SANTA ANA <br />Based on site observations, the undersigned Senior Residential Construction Specialist (SRCS) certifies that to the best of their <br />knowledge, information and belief, the work summarized above and covered by this Progress Payment Request has been completed in <br />accordance with the NSP Rental Development Agreement. <br />Date <br />Senior Residential Construction Specialist (Signature) <br />The undersigned certifies that to the best of their knowledge, information and belief, this Progress Payment Request has been properly <br />prepared and documented and authorizes the disbursement of funds to cover the amount requested. <br />Date Housing Programs Coordinator (Signature) <br />Kequirea Attachments: Project Continuation Sheet, Lien Release <br />