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EXHIBIT A <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. <br /> A-1 <br />