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<br />SCHEDULE A <br />REQUEST FOR DISBURSEMENT OF FUNDS <br />Date: <br />2 <br />1. The amount of the requested disbursement: <br />The method of disbursement: <br />^ Official Check (made payable to: <br />Mailed to: <br />^ RBC Bank (USA) Account Transfer to Acct #: <br />Acct name: <br />^ Wire Transfer Bank Name: <br />Credit Acct Name: <br />Credit Acct #: <br />Special Instructions: <br />3. A brief description of the purpose of the payment: <br />4. The undersigned certifies as follows: <br />(1) .Payment of the disbursement for the purpose requested will not cause the undersigned to be <br />in violation of any of its representations, warranties or covenants under the Installment <br />Financing Contract dated September 4, 2008 (the "Contract") including, but not limited to its <br />covenants in Section 5.10 of the Contract. <br />(2) The amounts requested to be disbursed were properly incurred in connection with the <br />acquisition of the Equipment and were not subject of any previous request for disbursement. <br />(3) The Equipment for which the disbursement is requested has been finally accepted by the <br />County. <br />5. Attached hereto are the following: Bills, receipts, invoices, or other documents evidencing the <br />amounts and purposes for which the disbursement is requested. <br />County of Orange <br />By: <br />Original Loan Amount: $1,191,,638.00 <br />ABA#: <br />(Title) <br />25 <br />