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Ohio Water Development Authority
Fund Payment Request
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LGA Name:
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Akron
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Project Name:
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Hampton Ridge Sanitary Sewer
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Account Number:
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8625
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EPA Loan Number:
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CS390095-0138
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Disbursement Request:
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Date Prepared:
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Contractor Name
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Encumbered
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Disbursed
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Balance
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A |
S.E.T. Incorporated |
$1,010,915.69 |
$886,848.70 |
$124,066.99 |
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CO |
Contingencies |
$104,520.00 |
$0.00 |
$104,520.00 |
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TS8 |
Force Account |
$34,288.00 |
$0.00 |
$34,288.00 |
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Total: |
$1,149,723.69
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$886,848.70
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$262,874.99
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I hereby certify that this request for disbursement is a true and accurate request for disbursement, that it is made in accordance with the terms and conditions of the above referenced loan agreement, and all hourly wages on the project have been paid in accordance with the wage rates as required by the above referenced loan agreement. This request for disbursement represents eligible project costs previously un-requested, and that an inspection has been performed with all work being done in accordance with the terms of the contract award(s).
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Signature of Preparer
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Name of Preparer (Printed);
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Signature of Borrower's Authorized Representative
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Ohio Water Development Authority
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Name of Borrower's Authorized Representative (Printed);
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