ORANGE HOUSING DEVELOPMENT CORPORATION AND C & C DEVELOPMENT (2)

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4pucauon ~,i CITY OF SANTA ANA Housing & Neighborhood Development 20 Civic Center Plaza / 3rd Floor / P.O. Box 1988 / M-26 /Santa Ana, CA 92702 (714)667-2250 REQUEST FOR FINAL PAYMENT Date: NSP Grant Services Agreement ANR Homes, Inc. (Developer) Property Address: AMOUNT REQUESTED: AMOUNT RETAINED: AMOUNT DISBURSED: PAYABLE TO: O OFFICE USE ONLY O SOURCE OF FUNDS ^ HOME CJ CALHOME Q 7AX INCREMENT ^ CDBG TOTAL. DISBURSEMENT IDS NUMBER: ESCROW NUMBER: ACCOUNT NUMBER / W.O.#: DEVELOPER The undersigned CONTRACTOR: (1) Certifies that to the best of their knowledge, information and belief, the work summarized on the attached invoice and covered by this Final Payment Request has been completed in accordance with all of the terms and conditions of the NSP Grant Services Agreement; (2) Certifies that they have obtained all required building permits, inspections and approvals for the work covered by this Final Payment Request. Date Pnnt Name /Title Signature CITY OF SANTA ANA Based on site observations, the undersigned Senior Residential Construction Specialist (BRCS) certifies that to the best of their knowledge, information and belief, the work summarized above and covered by this Final Payment Request has been completed in accordance with the terms and conditions of the NSP Grant Services Agreement.. Date Senior Residential Construction Specialist (Signature) The undersigned certifies that to the best of their knowledge, information and belief, this Final Payment Request has been properly prepared and documented and authorizes the disbursement of funds to cover the amount requested. Date Housing Programs Coordinator (Signature) Required Attachments: Project Continuation Sheet, Lien Release, Certificate of Final Inspection, Notice of Completion May 2009