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/~catl°n ls~ <br />CITY OF SANTA ANA <br />Housing & Neighborhood Development <br />20 Civic Center Plaza / 3`° Floor / P.O. Box 1988 / M-261 Santa Ana, CA 92702 <br />(714) 667-2250 <br />REQUEST FOR PROGRESS PAYMENT NUMBER: <br />Date: O OFFICE USE ONLY D <br />NSP Grant Services Agreement <br />ANR Homes, Inc. (Developer) <br />Project Address: <br />AMOUNT REQUESTED: <br />AMOUNT RETAINED: <br />AMOUNT DISBURSED: <br />PAYABLE TO: <br />ANR HOMES, INC <br />SOURCE OF FUNDS <br />C HOME <br />CALHOME <br />':TAX INCREMENT <br />'7 CDBG <br />C <br />TOTAL DfSBURSEMENT <br /> <br />AMOUNT <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 />Grant Services Agreement; (2) Certifies that they have obtained all required building permits, inspections and approvals for the work <br />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 (BRCS) 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 Grant Service Agreement. <br />Date Sernor 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 />Required Attachments: Project Continuation Sheet, Lien Release <br />May 2009 <br />