Ohio Water Development Authority
Fund Payment Request

LGA Name: Akron
Project Name: Hazel Storage Basin (Rack 10 and 11) CSO
Account Number: 8357
EPA Loan Number: CS390095-0160
Disbursement Request:
Date Prepared:

  Contractor Name Encumbered Disbursed Balance
A The Great Lakes Construction Co. $28,598,201.34 $27,382,061.63 $1,216,139.71
CO Contingencies $3,914,850.66 $0.00 $3,914,850.66
PL Planning Loan $1,883,111.01 $1,883,111.01 $0.00
TS Technical Services $440,316.00 $435,861.21 $4,454.79
TS3 Construction Management $1,200,101.00 $782,847.59 $417,253.41
    Total: $36,036,580.01 $30,483,881.44 $5,552,698.57

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).  
     
   
  
  
  
  
  

Signature of Preparer
 

Name of Preparer (Printed);
 

Signature of Borrower's Authorized Representative
 
Ohio Water Development Authority

Name of Borrower's Authorized Representative (Printed);