Exhibit A Form of Certificate of Costs EXHIBIT A
FORM OF CERTIFICATE OF COSTS
CERTIFICATE OF COSTS
TO: City of Salina,Kansas
Attention: City Manager
Re: Stone Lake Addition Improvement District and Cost Recovery Area
Terns not otherwise defined herein shall have the meaning ascribed to such terms in the
Improvement District Development Agreement and Capital Cost Recovery Agreement dated as of
2012 (the "Agreement")between the City and the Developer.
In connection with the Agreement,the undersigned hereby states and certifies that:
1. Each item listed on Schedule 1 hereto is an Improvement Cost and was incurred in
connection with the construction of the Improvement District Improvements after
_, 20_ [INSERT DATE DISTRICT CREATED BY RESOLU770NJ. Attached hereto are invoices
and other supporting documentation showing proof that each cost listed in Schedule 1 is an Improvement
Cost
2. These Improvement Costs are reimbursable under the Improvement District Proceedings,
the Act and the Agreement.
3. Each item listed on Schedule2 hereto is_a Cost Recovery,Improvement.Cost and was
incurred in 'connection: with the Agreement Attached hereto are. ,invoices and other supporting
documentation showing proof that.each cost listed in Schedule 2 is a,Cost Recovery Improvement Cost.
4. Each item•listed on Schedule.l has.not•previously.been paid or reimbursed from money
derived'from any project find established by the issuance of any Improvement District Obligations or
Cost Recovery:Obligations,and no part thereof has been included io any other certificate previously filed
with the City:
5. There has not been filed with or served upon the Developer any notice of any lien, right
of lien or attachment upon or claim affecting the right of any person, firm or corporation to receive
payment of the amounts stated in this request, except to the extent any such lien is being contested in
good faith.
6. All necessary permits and approvals required for the work for which this certificate
relates were issued and were in full force and effect at the time such work was being performed.
7. All work for which payment or reimbursement is requested has been performed in a good
and workmanlike manner and in accordance with the Agreement.
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8. The Developer is not in default or breach of any term or condition of the Agreement, and
no event has occurred and no condition exists which constitutes a Developer Event of Default under the
Agreement.
9. All of the Developer's representations set forth in the Agreement remain true and correct
as of the date hereof.
Dated this 1$ day of 71e,PtwiNec`20//tr
SPARROWHAWK LAND,LLC
a Kansas Imited liability company
By: c"-'UC.e
a..A.L.G.,7
Name:Dane Q.Barclay
Title: Manager
AISOP SAND,INC.
a Kansas Corporation
By:
Name:Dane Q.Barclay ll
Title: President
Approved for Payment this_day of ,2012:
CITY OF SALINA,KANSAS
By:
Title:
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