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<br />A-1 <br />EXHIBIT A <br /> <br />STATEMENT NO. REQUESTING DISBURSEMENT OF FUNDS FROM <br />PROJECT FUND PURSUANT TO SECTION 4.3 OF THE TRUST INDENTURE <br />BETWEEN THE CITY OF SOUTH BEND, INDIANA AND U.S. BANK TRUST <br />COMPANY, NATIONAL ASSOCIATION <br />Pursuant to Section 4.3 of the Trust Indenture (the “Indenture”) dated as of <br />___________ 1, 2025, between the City of South Bend, Indiana (the “Issuer”) and <br />_______________________________ (the “Trustee”), the undersigned, as the Authorized <br />Representative (as defined in the Indenture) of J.C. Hart Company, Inc. (the “Company”), <br />hereby requests and authorizes the Trustee, as depository of the Project Fund created by <br />and as defined in the Indenture to pay to the Company or to the person(s) listed on the <br />Disbursement Schedule attached hereto out of the moneys on deposit in the Project Fund <br />the aggregate sum of $___________, to pay such person(s) or to reimburse the Company <br />in full, as indicated in the Disbursement Schedule, for advances, payments and <br />expenditures made by it in connection with the items listed in the Disbursement Schedule. <br />In connection with the foregoing request and authorization, the undersigned <br />hereby certifies that: <br />(a) Each item for which disbursement is requested hereunder is properly <br />payable out of the Project Fund in accordance with the terms and conditions of the <br />Indenture, and none of those items has formed the basis for any disbursement heretofore <br />made from the Project Fund; <br />(b) Each such item is or was necessary in connection with the acquisition, <br />construction, equipping, installation or improvement of the property comprising the <br />Project, as defined in the Indenture; <br />(c) This statement and all exhibits hereto, including the Disbursement <br />Schedule, shall be conclusive evidence of the facts and statements set forth herein and shall <br />constitute full warrant, protection and authority to the Trustee for its actions taken pursuant <br />hereto; <br />(d) This statement constitutes the approval of the Company of each <br />disbursement hereby requested and authorized; and <br />(e) To the best of our knowledge, there is no current or existing Event of <br />Default pursuant to the terms of the Indenture and no event exists which by notice of or <br />passage of time or both would constitute such Event of Default under the Indenture.