Agenda - 06-18-2013 - 5l - Laserfiche WebLink

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Lease Number:09065 Equipment Schedule: 001 EXHIBIT A PAYMENT REQUEST FORM NO. W SUNTRUST BANK, as Escrow Agent under an Escrow Agreement dated as of June 3, 2013 (the "Escrow Agreement ") by and among Escrow Agent, SUNTRUST EQUIPMENT FINANCE & LEASING CORP., as Lessor, and ORANGE GROVE VOLUNTEER FIRE COMPANY, INC., as Lessee, is hereby requested to pay, from the Equipment Acquisition Fund, to the person or entity designated below as payee, that amount set forth opposite each such name, in payment of the Acquisition Costs of the Equipment designated opposite such payee's name and described on the attached page(s). The terms capitalized in this Payment Request Forth but not defined herein shall have the meanings assigned to them in the Escrow Agreement. Payee Lessee hereby certifies that: Amount Equipment 1. Attached hereto is a duplicate original or certified copy of the following documents relating to the order, delivery and acceptance of the Equipment described in this Payment Request Form: (a) a manufacturer's or dealer's invoice; and (b) unless this Payment Request Form relates to partial payment of a Vendor, as defined in the Lease, in connection with a purchase order approved by Lessor, Lessee's Acceptance Certificate relating to the Equipment. The representations and warranties contained in the Lease are true and correct as of the date hereof. 3. No Event of Default, as each such term is defined in the Lease, or event which with the giving of notice or passage of time or both would constitute an Event of Default, has occurred. Dated: , 20_. ORANGE GROVE VOLUNTEER FIRE COMPANY, INC., Lessee By Name: Bill Waddell Title: President Date: 35 5/16/ 2013: BQ- ESCfamtem.D0C /rev.01 /04.st1 SUNTRUST EQUIPMENT FINANCE & LEASING CORP., Lessor By Name: Title: Date: