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EXHIBIT D <br />DRAW REQUEST <br />PAYMENT REQUEST <br />CITY OF SANTA ANA RESIDENTIAL REHABILITATION PROGRAM <br />HOMEOWNER: JOB ADDRESS: <br />RCS: <br />? PROGRESS PAYMENT NUMBER ? CHANGE ORDER # PAYMENT <br />? FINAL PAYMENT ? RELEASE OF RETENTION <br />? TERMITE PAYMENT ? OTHER: <br />PAYEE: PAYEE ADDRESS: <br />AMOUNT REQUESTED: <br />CONTRACTOR (PAYEE) HOMEOWNER <br />The undersigned CONTRACTOR: (1) Certifies that to The undersigned HOMEOWNER: (1) Certifies that to the best of their knowledge, <br />the best of their knowledge, information and belief, the information and belief, the work covered by this Payment Request has been <br />work covered by this Payment Request has been completed to their satisfaction and in accordance with the approved Housing <br /> <br />completed in accordance with the approved Housing Rehabilitation Work Contract; (2) Authorizes payment to the CONTRACTOR in the <br /> <br />Rehabilitation Work Contract; (2) Certifies that they amount requested, (3) Acknowledges and agrees that inspections by the <br />Residential Construction Specialist (RCS) are performed for financial purposes and <br />have obtained all required building permits, inspections to ensure compliance with program requirements, and should not be relied upon as <br />and approvals for the work covered by this Payment a surety that the work was done properly. <br />Request; (3) Certifies that they have not promised or <br />iven the HOMEOWNER a <br />h <br />t <br />b <br />t <br />g <br />cas <br />paymen <br />or re <br />a <br />e. <br /> HOMEOWNER (PRINT NAME) <br /> <br />CONTRACTOR (PRINT NAME) <br /> HOMEOWNER SIGNATURE <br /> DATE <br />CONTRACTOR SIGNATURE <br />DATE <br />CITY OF SANTA ANA (RCS) CITY OF SANTA ANA <br />Based on site observations, the undersigned Residential The undersigned certify that to the best of their knowledge, information and <br />Construction Specialist (RCS) certifies that to the best of their belief, this Payment Request has been properly prepared and documented and <br />knowledge, information and belief, the work covered by this authorize the disbursement of funds to cover the amount requested. <br />Payment Request has been completed in accordance with the <br />approved Housing Rehabilitation Work Contract and complies with <br />program requirements. SRCS SIGNATURE DATE <br />EXHIBIT 1 <br />25H-37