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EXHIBIT F i J )1? CITY OF SANTA ANA Housing & Neighborhood Development 20 Civic Center Plaza / 3`" Floor / P.O. Box 1988 / M-26 / Santa Ana, CA 92702 (714) 667-2250 FINAL PAYMENT REQUEST Date Project Number: Homeowner: Address: Santa Ana, CA Telephone #: PROGRESS PAYMENT #: AMOUNT APPROVED: AMOUNT RETAINED (-10%) AMOUNT TO BE DISBURSED: PAYABLE T0: V OFFICE USE ONLY V SOURCE OF FUNDS HOME CALHOME TAX INCREMENT CDBG TOTAL DISBURSEMENT AMOUNT 1 IDS NUMBER: ESCROW NUMBER: ACCOUNT NUMBER / W.O.#: CONTRACTOR 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 Housing Rehabilitation Work Contract; (2) Certifies that they have obtained all required building permits, inspections and approvals for the work covered by this Final Payment Request; (3) Certifies that they have not promised or given the HOMEOWNER a cash payment or rebate. Date Contractor (Signature) HOMEOWNER The undersigned HOMEOWNER: (1) 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 to their satisfaction and in accordance with the terms and conditions of the Housing Rehabilitation Work Contract; (2) Authorizes payment to the CONTRACTOR in the amount requested; (3) Acknowledges and agrees that inspections by the Residential Construction Specialist (RCS) are performed for financial purposes and to ensure compliance with program requirements, and should not be relied upon as a surety that the work was done properly. Date Homeowner (Signature) CITY OF SANTA ANA Based on site observations, the undersigned Residential Construction Specialist (RCS) 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 Housing Rehabilitation Work Contract and in compliance with program requirements. Date Residential Construction Specialist (Signature) The undersigned certify that to the best of their knowledge, information and belief, this Final Payment Request has been properly prepared and documented and authorize the disbursement of funds to cover the amount requested. Date Senior Residential Construction Specialist (Signature) Date Housing Programs Coordinator (Signature) Required Attachments: Contractor' s Invoice, Full Release, Punch List, Certificate of Final Inspection, Notice of Completion (if applicable) 08/2005