HomeMy Public PortalAbout3c-Form of Disbursement RequestExhibit 3
Form of Disbursement Request
City National Bank of Florida
25 West Flagler Street
Miami, FL 33130
Attention: Elizabeth Perkins(elizabeth.perkins@cncapitalfinance.com)
Re: Master Lease Purchase Agreement dated as of March 2, 2017 between City
National Bank of Florida ("Lessor"), and the Village of Key Biscayne, a political
subdivision of the State of Florida ("Lessee") and Lease Schedule No. 2 dated
March 2, 2017, between Lessor and Lessee (collectively, the "Lease")
In accordance with the terms of the Lease, the undersigned authorized officer of Lessee hereby
requests Lessor disburse funds from the Project Account (as defined in the Lease) to pay the following
persons the following amounts for the following purposes.
Payee's Name and Address
Invoice Number
Dollar Amount
Purpose
The undersigned hereby certifies as follows:
(i) 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.
(ii) The undersigned, as Authorized Representative, has no notice of any vendor's,
mechanic's or other liens or rights to liens, chattel mortgages, conditional sales contracts or security
interest which should be satisfied or discharged before such payment is made.
(iii) The Equipment is insured in accordance with the Lease.
(v) No Event of Default, and no event which with notice or lapse of time, or both, would
become an Event of Default, under the Lease has occurred and is continuing at the date hereof.
(vi) No Event of Nonappropriation has occurred and is continuing at the date hereof.
(vii) No material adverse change in Lessee's financial condition has occurred since the date of
the Lease.
Dated: VILLAGE OF KEY BISCAYNE, FLORIDA
By:
Name:
Title: