The following documents are attached hereto and made a part hereof: (a) invoice(s) for costs being
paid; (b) current IRS Form W-9 for the payee (unless such IRS Form W-9 has been previously submitted
to the Escrow Agent); and (c) lien waivers, if applicable.
IF REQUEST IS FOR REIMBURSEMENT, CHECK HERE (]. Lessee paid an invoice prior to the
commencement date identified in the Equipment Schedule and is requesting reimbursement for such
payment. A copy of evidence of such payment together with a copy of Lessee’s Declaration of Official
Intent and other evidence required by Lessor prior to Lessor’s approval hereof that Lessee has satisfied
the requirements for reimbursement set forth in Treas. Reg. 1.150-2 is hereby attached. Lessor’s
approval hereof shall evidence that Lessee has delivered to Lessor such required documentation.
IF REQUEST IS FINAL REQUEST, CHECK HERE OH. Lessee hereby certifies that (a) all of the
Equipment describedin the Agreement has been received in good condition and has been installedin
accordance with the Contract; (b) such Equipment is accepted “AS-IS, WHERE-IS”; (c) Lessee has
inspected the Equipment, and determined that it is in good working order and complies with all
purchase orders, contracts and specifications; (d) Lessee has fully and satisfactorily performed all
covenants and conditions to be performed by it as of this date under the Agreement with regard to such
Equipment; (e) Lessee waives any right to revoke its acceptance; and (f) the Equipment is fully insured
in accordance with Section 22 of the Agreement. This certificate is made without prejudice to any rights
against third parties which may exist as of the date hereof or which may subsequently come into being.
Date: , 20
Approved for Payment:
CAPITAL ONE PUBLIC FUNDING, LLC CITY OF NASHUA, NEW HAMPSHIRE, ON
(assignee of MUNICIPAL LEASING BEHALF OF NASHUA SCHOOL DISTRICT,
CONSULTANTS, LLC), as Lessor as Lessee
By: By:
Name: Name:
Title: Title:
