Common use of PROJECT FINANCING AND EXPENSES SCHEME Clause in Contracts

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant $498,510 SUBTOTAL $498,510 TOTAL FINANCIAL RESOURCES $5,539,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 81,000 SUBTOTAL $5,040,490 81,000 - Grant $498,510 976,360 - Loan $449,640 SUBTOTAL $498,510 1,426,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,507,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 137,000 ii) Right-of-Way $0 iii) Construction $5,539,000 1,370,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,507,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Mount Healthy, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB24X/CB25X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 137,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,370,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,507,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,426,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 81,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 81,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,507,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx X. Xxxxxx, Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 324,140 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 324,140 - Grant $498,510 1,219,382 SUBTOTAL $498,510 1,219,382 TOTAL FINANCIAL RESOURCES $5,539,000 1,543,522 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,543,522 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,543,522 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13DOX03. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,543,522.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,543,522.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,219,382 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 324,140.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 324,140.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,543,522.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 0 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA $1,470,216 - OEPA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 1,470,216 v) OPWC Funds: $498,510 450,000 SUBTOTAL $498,510 450,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,920,216 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $0 - Construction Administration $174,566 ii) Right-of-Way Acquisition Expenses: $0 iii) Construction Costs $5,539,000 1,494,728 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 250,922 TOTAL ESTIMATED COSTS $5,539,000 1,920,216 Statement requesting the disbursement of funds from the OPWC Ohio Public Works Commission (OPWC) pursuant to Section V 6 of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission OPWC (the "Director") and Delaware The City of New Carlisle (023-54334), Xxxxx County (the "Recipient"), dated 07/01/2020December 17, 2012, for the sole and express purpose of financing the Capital Improvement Project capital improvement project defined and described in Appendix A of the Project Agreement (the "Project") and named and numbered as DQX13. EXPENDITURES PROGRESS: Xxxxx Xxxxx 000 Xxxxxxxx, XXX00. (1) AS PER AGREEMENT (2) PAID PRIOR TO THIS DRAW (3) AS PART OF THIS DRAW (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) ) A) Project Engineering Costs 1) Preliminary Engineering $0.00 0 $ $ $ B) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,494,728 $ $ $ D) Materials Purchased Directly $0.00 0 $ $ $ E) Permits, Advertising, Legal $0.00 0 $ $ $ F) Construction Contingencies $0.00 250,922 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,920,216 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) DATE H) OPWC Funds 498,510 $450,000 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0 $ $ $ J) Other Revenue Public Revenues 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 1,470,216 $ $ $ K) Total Local and Other Revenue Public Revenues $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,470,216 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 0 - Grant Loan $498,510 2,192,059 SUBTOTAL $498,510 2,192,059 TOTAL FINANCIAL RESOURCES $5,539,000 2,192,059 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 2,192,059 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 2,192,059 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Xxxxxxxx, Xxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CJ02V. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 2,192,059.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 2,192,059.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 2,192,059 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 0.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,192,059.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxxx, Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 342,600 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $1,471,200 - FmHA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 1,813,800 v) OPWC Funds: $498,510 175,000 SUBTOTAL $498,510 175,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,988,800 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $35,000 - Final Design $81,000 - Other Engineering Services $179,200 ii) Acquisition Expenses: - Land $0 ii) - Right-of-Way $0 60,000 iii) Construction Costs $5,539,000 1,476,000 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 10,000 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 147,600 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND The City of Port Clinton, (123-64150), Ottawa County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Sixth Street Reconstruction (XXX - Sixth St) Phase 2, CEX07. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 35,000 $ $ $ B2) Final Design $81,000 $ $ $ 3) Other Engineering Services $179,200 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 60,000 $ $ $ C) Construction Costs $5,539,000.00 1,476,000 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 10,000 $ $ $ F) Construction Contingencies $0.00 147,600 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,988,800 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $DATE

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 1,008,492 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 1,008,492 v) OPWC Funds: $498,510 1,099,999 SUBTOTAL $498,510 1,099,999 TOTAL FINANCIAL RESOURCES $5,539,000 2,108,491 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $162,192 - Other Engineering Services $162,192 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 iii) Construction Costs $5,539,000 1,621,915 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 162,192 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND The City of Columbus, (049-18000), Franklin County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Intersection Safety Improvements, CCX03. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $162,192 $ $ $ 3) Other Engineering Services $162,192 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,621,915 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 0 $ $ $ F) Construction Contingencies $0.00 162,192 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 2,108,491 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $1,099,999 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 0 $ $ $ 2) Public Revenues $5,040,490.00 1,008,492 $ $ $ J3) Private Revenues $0 $ $ $ K) Other Revenue Public Revenues 1) ODOT/FHWA ODOT $0.00 0 $ $ $ 2) OEPA/OWDA FmHA $0.00 0 $ $ $ 3) CDBG OEPA $0.00 0 $ $ $ 4) USDA OWDA $0.00 0 $ $ $ 5) Other CDBG $0.00 0 $ $ $ K6) Total Local and Other Revenue $5,040,490.00 0 $ $ $ L) Total Financing (H+K) Local and Other Public Revenues $5,539,000.00 1,008,492 $ $ $$ Is this the final request for disbursement of OPWC funds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO If the answer is YES, skip to the section entitled "FINAL DISBURSEMENT REQUEST and PROJECT COMPLETION REPORT".

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 2,058,038 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 2,058,038 - Grant $498,510 749,000 - Loan $251,000 SUBTOTAL $498,510 1,000,000 TOTAL FINANCIAL RESOURCES $5,539,000 3,058,038 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 458,160 ii) Right-of-Way $0 80,000 iii) Construction $5,539,000 2,290,798 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 229,080 TOTAL ESTIMATED COSTS $5,539,000 3,058,038 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Columbus, Franklin County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC18X/CC19X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 458,160.00 $ $ $ B) Right-ofWay $0.00 80,000.00 $ $ $ C) Construction $5,539,000.00 2,290,798.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 229,080.00 $ $ $ G) Total Expenditures $5,539,000.00 3,058,038.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,000,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 2,058,038.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,058,038.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 3,058,038.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxx, City Engineer/Administrator Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 992,475 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 992,475 - Grant $498,510 250,000 SUBTOTAL $498,510 250,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,242,475 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 146,900 ii) Right-of-Way $0 50,000 iii) Construction $5,539,000 950,522 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 95,053 TOTAL ESTIMATED COSTS $5,539,000 1,242,475 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Trumbull County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF22X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 146,900.00 $ $ $ B) Right-ofWay $0.00 50,000.00 $ $ $ C) Construction $5,539,000.00 950,522.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 95,053.00 $ $ $ G) Total Expenditures $5,539,000.00 1,242,475.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 250,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 992,475.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 992,475.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,242,475.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 541,110 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 541,110 v) OPWC Funds: $498,510 519,890 SUBTOTAL $498,510 519,890 TOTAL FINANCIAL RESOURCES $5,539,000 1,061,000 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $0 - Other Engineering Services $0 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 iii) Construction Costs $5,539,000 1,009,702 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 51,298 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Toledo, (095-77000), Xxxxx County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Xxxxx Avenue - Shoreland Avenue to Alexis Road, CLX04. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $0 $ $ $ 3) Other Engineering Services $0 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,009,702 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 0 $ $ $ F) Construction Contingencies $0.00 51,298 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,061,000 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER AGREEMENT USED PRIOR TO THIS DRAW AS PART OF PAID THIS DRAW USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $)

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 979,987 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 979,987 - Grant Loan $498,510 487,500 SUBTOTAL $498,510 487,500 TOTAL FINANCIAL RESOURCES $5,539,000 1,467,487 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 190,507 ii) Right-of-Way $0 iii) Construction $5,539,000 1,226,980 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 50,000 TOTAL ESTIMATED COSTS $5,539,000 1,467,487 Ohio Public Works Commission Disbursement Request Form and Certification Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Huron, Erie County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CE38X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 190,507.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,226,980.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 50,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,467,487.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 487,500 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 979,987.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 979,987.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,467,487.00 $ $ $$ OPWC Control No.: CE38X Disbursement Request # If this is a final request (to be marked on top of page 3) or if this disbursement uses the remainder of your assistance, your Project file will be closed upon processing this request. As described in Appendix B of the Project Agreement, your minimum Percentage Contribution is 67% of the total Project cost. AUTHORIZED CERTIFICATIONS Changes to Project officials must be submitted in writing. PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx Xxxxx, Project Manager Date Phone CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER CERTIFICATION: Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 116,970 ii) Local Public Revenue Revenues $5,040,490 0 iii) Local Private Revenues iv) Other RevenuePublic Revenues: $0 - ODOT/FHWA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant $498,510 SUBTOTAL $498,510 TOTAL FINANCIAL RESOURCES $5,539,000 v) OPWC Funds: b) PROJECT ESTIMATED COSTS: : i) EngineeringProject Engineering Costs: $0 ii) Right-of-Way $0 iii) Construction Costs $5,539,000 278,500 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 27,850 Statement requesting the disbursement of funds from the OPWC pursuant to Section V VI of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware The Village of Roaming Shores, (007-67600), Ashtabula County (the "Recipient"), dated 07/01/2020July 1, 2016, for the sole and express purpose of financing the Capital Improvement Project capital improvement project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. Plum Creek Cove Forcemain & Xxxxx Xxxx Xxxxxxxxxx, XX00X/XX00X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PAID PRIOR AS PART OF PAID TO DATE A) Project Engineering Costs AGREEMENT DISBURSED TO THIS DRAW THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 7,000 $ $ $ 2) Final Design $20,850 $ $ $ 3) Construction Administration $0 $ $ $ B) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 278,500 $ $ $ D) Materials Purchased Directly $0.00 0 $ $ $ E) Permits, Advertising, Legal $0.00 0 $ $ $ F) Construction Contingencies $0.00 27,850 $ N/A $ N/A $ G) Total Expenditures $5,539,000.00 $ $ $ N/A FINANCING PROGRESS: (1) AS PER AGREEMENT (2) USED PRIOR TO THIS DRAW (3) AS PART OF THIS DRAW (4) AS PER PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 116,970 $ $ $ J) Other Revenue Public Revenues 1) ODOT/FHWA $0.00 0 $ $ $ Is this the final request for disbursement of OPWC funds? . . . . . . . . . . . . . . . . . . . . . . . . . YES NO I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Phone Pursuant to Section VI. B. and VI. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer of the Recipient, as both are designated in Appendix B of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix C of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $Each item for which payment is requested hereunder is or was necessary in connection with the performance of the project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 647,085 iii) Other Revenue: - ODOT/FHWA $0 7,947,527 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 8,594,612 - Grant Loan $498,510 1,986,882 SUBTOTAL $498,510 1,986,882 TOTAL FINANCIAL RESOURCES $5,539,000 10,581,494 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 936,437 ii) Right-of-Way $0 iii) Construction $5,539,000 8,768,234 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 876,823 TOTAL ESTIMATED COSTS $5,539,000 10,581,494 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Middleburg Heights, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA09W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 936,437.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 8,768,234.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 876,823.00 $ $ $ G) Total Expenditures $5,539,000.00 10,581,494.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,986,882 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 647,085.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 7,947,527.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 8,594,612.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 10,581,494.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxx, Director of Public Service Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 144,200 ii) Local Public Revenue $5,040,490 748,500 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 892,700 - Grant $498,510 604,300 SUBTOTAL $498,510 604,300 TOTAL FINANCIAL RESOURCES $5,539,000 1,497,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,497,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,497,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB18W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,497,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,497,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 604,300 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 144,200.00 $ $ $ 2) Public Revenues $5,040,490.00 748,500.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 892,700.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,497,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxxxx, County Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 0 - Grant Loan $498,510 1,919,015 SUBTOTAL $498,510 1,919,015 TOTAL FINANCIAL RESOURCES $5,539,000 1,919,015 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 88,180 ii) Right-of-Way $0 iii) Construction $5,539,000 1,664,396 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 166,439 TOTAL ESTIMATED COSTS $5,539,000 1,919,015 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Greenville, Darke County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CK06W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 88,180.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,664,396.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 166,439.00 $ $ $ G) Total Expenditures $5,539,000.00 1,919,015.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,919,015 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 0.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,919,015.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxx Xxxxxx, Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 543,604 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 543,604 - Grant $498,510 312,378 - Loan $209,907 SUBTOTAL $498,510 522,285 TOTAL FINANCIAL RESOURCES $5,539,000 1,065,889 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 96,645 ii) Right-of-Way $0 iii) Construction $5,539,000 876,585 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 5,000 vi) Construction Contingencies $0 87,659 TOTAL ESTIMATED COSTS $5,539,000 1,065,889 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Village of Xxxxxxxx, Xxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CS02X/CS03X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 96,645.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 876,585.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 5,000.00 $ $ $ F) Construction Contingencies $0.00 87,659.00 $ $ $ G) Total Expenditures $5,539,000.00 1,065,889.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 522,285 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 543,604.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 543,604.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,065,889.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxx Xxxxxx, Administrator Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 3,699,845 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 3,699,845 - Grant $498,510 2,798,404 - Loan $937,784 SUBTOTAL $498,510 3,736,188 TOTAL FINANCIAL RESOURCES $5,539,000 7,436,033 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 1,051,698 ii) Right-of-Way $0 600,000 iii) Construction $5,539,000 5,258,486 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 525,849 TOTAL ESTIMATED COSTS $5,539,000 7,436,033 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Columbus, Franklin County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC12W/CC13W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 1,051,698.00 $ $ $ B) Right-ofWay $0.00 600,000.00 $ $ $ C) Construction $5,539,000.00 5,258,486.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 525,849.00 $ $ $ G) Total Expenditures $5,539,000.00 7,436,033.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 3,736,188 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 3,699,845.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 3,699,845.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 7,436,033.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxx, City Engineer/Administrator Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,974,164 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,974,164 - Grant $498,510 2,465,374 - Loan $491,210 SUBTOTAL $498,510 2,956,584 TOTAL FINANCIAL RESOURCES $5,539,000 4,930,748 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 586,896 ii) Right-of-Way $0 iii) Construction $5,539,000 3,932,956 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 17,600 vi) Construction Contingencies $0 393,296 TOTAL ESTIMATED COSTS $5,539,000 4,930,748 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Berea, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA12X/CA16X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 586,896.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,932,956.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 17,600.00 $ $ $ F) Construction Contingencies $0.00 393,296.00 $ $ $ G) Total Expenditures $5,539,000.00 4,930,748.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 2,956,584 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,974,164.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,974,164.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 4,930,748.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 17,434,978 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 17,434,978 - Grant $498,510 1,498,000 - Loan $502,000 SUBTOTAL $498,510 2,000,000 TOTAL FINANCIAL RESOURCES $5,539,000 19,434,978 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 2,543,842 ii) Right-of-Way $0 2,900,000 iii) Construction $5,539,000 12,719,215 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 1,271,921 TOTAL ESTIMATED COSTS $5,539,000 19,434,978 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Columbus, Franklin County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC10X/CC11X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 2,543,842.00 $ $ $ B) Right-ofWay $0.00 2,900,000.00 $ $ $ C) Construction $5,539,000.00 12,719,215.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 1,271,921.00 $ $ $ G) Total Expenditures $5,539,000.00 19,434,978.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 2,000,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 17,434,978.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 17,434,978.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 19,434,978.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxx, City Engineer/Administrator Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 674,843 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 674,843 - Grant $498,510 475,000 - Loan $475,000 SUBTOTAL $498,510 950,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,624,843 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,504,484 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 120,359 TOTAL ESTIMATED COSTS $5,539,000 1,624,843 Statement requesting the disbursement of funds from the OPWC Ohio Small Government Capital Improvements Program (OSGCIP) pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director Administrator of the Ohio Public Works Commission OSGCIP (the "DirectorAdministrator") and Delaware Village of Fort Loramie, Shelby County (the "Recipient"), dated 07/01/202008/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CT66X/CT67X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,504,484.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 120,359.00 $ $ $ G) Total Expenditures $5,539,000.00 1,624,843.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 950,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 674,843.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 674,843.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,624,843.00 $ $ $$ Greenback Road Reconstruction I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxx, Project Manager Date Phone

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 436,307 - CDBG $0 - USDA $0 - Other $0 1,500,000 SUBTOTAL $5,040,490 1,936,307 - Grant $498,510 500,000 SUBTOTAL $498,510 500,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,436,307 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 316,317 ii) Right-of-Way $0 35,000 iii) Construction $5,539,000 1,895,445 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 189,545 TOTAL ESTIMATED COSTS $5,539,000 2,436,307 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Trumbull County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF06X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 316,317.00 $ $ $ B) Right-ofWay $0.00 35,000.00 $ $ $ C) Construction $5,539,000.00 1,895,445.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 189,545.00 $ $ $ G) Total Expenditures $5,539,000.00 2,436,307.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 500,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 436,307.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 1,500,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,936,307.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,436,307.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx X. Xxxxxxxxx, Controller Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 2,470,975 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 2,470,975 - Grant $498,510 131,250 - Loan $131,250 SUBTOTAL $498,510 262,500 TOTAL FINANCIAL RESOURCES $5,539,000 2,733,475 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 311,400 ii) Right-of-Way $0 25,000 iii) Construction $5,539,000 2,075,675 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 10,000 vi) Construction Contingencies $0 311,400 TOTAL ESTIMATED COSTS $5,539,000 2,733,475 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Northwestern Water and Sewer District (Dist 5), Wood County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CE17X/CE18X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 311,400.00 $ $ $ B) Right-ofWay $0.00 25,000.00 $ $ $ C) Construction $5,539,000.00 2,075,675.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 10,000.00 $ $ $ F) Construction Contingencies $0.00 311,400.00 $ $ $ G) Total Expenditures $5,539,000.00 2,733,475.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 262,500 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 2,470,975.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,470,975.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,733,475.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 662,365 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 662,365 - Grant $498,510 662,365 SUBTOTAL $498,510 662,365 TOTAL FINANCIAL RESOURCES $5,539,000 1,324,730 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,324,730 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,324,730 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB18X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,324,730.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,324,730.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 662,365 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 662,365.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 662,365.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,324,730.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 235,000 - CDBG $0 650,000 - USDA $0 - Other $0 950,000 SUBTOTAL $5,040,490 1,835,000 - Grant $498,510 500,000 SUBTOTAL $498,510 500,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,335,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 400,500 ii) Right-of-Way $0 iii) Construction $5,539,000 1,750,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 9,500 vi) Construction Contingencies $0 175,000 TOTAL ESTIMATED COSTS $5,539,000 2,335,000 Statement requesting the disbursement of funds from the OPWC Ohio Small Government Capital Improvements Program (OSGCIP) pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director Administrator of the Ohio Public Works Commission OSGCIP (the "DirectorAdministrator") and Delaware Village of Xxxxxx Xxxx, Paulding County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CT25W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 400,500.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,750,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 9,500.00 $ $ $ F) Construction Contingencies $0.00 175,000.00 $ $ $ G) Total Expenditures $5,539,000.00 2,335,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 500,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 235,000.00 $ $ $ 3) CDBG $0.00 650,000.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 950,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,835,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,335,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx Xxxxxx, Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OSGCIP in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OSGCIP; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,000,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,000,000 - Grant $498,510 535,401 SUBTOTAL $498,510 535,401 TOTAL FINANCIAL RESOURCES $5,539,000 1,535,401 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,535,401 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,535,401 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Mahoning County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF03X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,535,401.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,535,401.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 535,401 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,000,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,000,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,535,401.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxx X. Xxxxxxxx, County Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 3,082,843 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 3,082,843 - Grant $498,510 1,027,614 SUBTOTAL $498,510 1,027,614 TOTAL FINANCIAL RESOURCES $5,539,000 4,110,457 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 654,690 ii) Right-of-Way $0 iii) Construction $5,539,000 3,455,767 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 4,110,457 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Garfield Heights, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA09X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 654,690.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,455,767.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 4,110,457.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,027,614 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 3,082,843.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 3,082,843.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 4,110,457.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxxx, Municipal Representative Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 203,000 ii) Local Public Revenue Revenues $5,040,490 118,225 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 464,175 SUBTOTAL $5,040,490 - Grant 785,400 v) OPWC Funds: $498,510 754,600 SUBTOTAL $498,510 754,600 TOTAL FINANCIAL RESOURCES $5,539,000 1,540,000 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $122,000 - Other Engineering Services $77,000 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 50,000 iii) Construction Costs $5,539,000 1,285,000 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 6,000 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Sylvania Township, (095-76025), Xxxxx County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") AND NAMED AND NUMBERED AS Township and named and numbered as DQX13County 2013 Roadway Improvements, CLX03. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $122,000 $ $ $ 3) Other Engineering Services $77,000 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 50,000 $ $ $ C) Construction Costs $5,539,000.00 1,285,000 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 6,000 $ $ $ F) Construction Contingencies $0.00 0 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,540,000 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER AGREEMENT USED PRIOR TO THIS DRAW AS PART OF PAID THIS DRAW USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $)

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 0 - Grant $498,510 545,777 - Loan $545,777 SUBTOTAL $498,510 1,091,554 TOTAL FINANCIAL RESOURCES $5,539,000 1,091,554 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 51,900 ii) Right-of-Way $0 iii) Construction $5,539,000 945,140 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 94,514 TOTAL ESTIMATED COSTS $5,539,000 1,091,554 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Cheviot, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB16X/CB17X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 51,900.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 945,140.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 94,514.00 $ $ $ G) Total Expenditures $5,539,000.00 1,091,554.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,091,554 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 0.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,091,554.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxx, Safety Service Director Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 783,975 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 300,000 SUBTOTAL $5,040,490 1,083,975 - Grant $498,510 1,497,999 - Loan $502,000 SUBTOTAL $498,510 1,999,999 TOTAL FINANCIAL RESOURCES $5,539,000 3,083,974 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 466,766 ii) Right-of-Way $0 50,000 iii) Construction $5,539,000 2,333,825 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 233,383 TOTAL ESTIMATED COSTS $5,539,000 3,083,974 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Reynoldsburg, Franklin County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC12X/CC13X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 466,766.00 $ $ $ B) Right-ofWay $0.00 50,000.00 $ $ $ C) Construction $5,539,000.00 2,333,825.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 233,383.00 $ $ $ G) Total Expenditures $5,539,000.00 3,083,974.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,999,999 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 783,975.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 300,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,083,975.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 3,083,974.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx Xxxxxxx, Development Director Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 356,900 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 2,262,200 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 2,619,100 - Grant $498,510 330,000 - Loan $620,000 SUBTOTAL $498,510 950,000 TOTAL FINANCIAL RESOURCES $5,539,000 3,569,100 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 3,244,600 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 324,500 TOTAL ESTIMATED COSTS $5,539,000 3,569,100 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Geauga County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CG53W/CG54W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,244,600.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 324,500.00 $ $ $ G) Total Expenditures $5,539,000.00 3,569,100.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 950,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 356,900.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 2,262,200.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,619,100.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 3,569,100.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx Xxxxxx, Sanitary Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 2,349,232 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 2,349,232 - Grant $498,510 195,507 - Loan $65,518 SUBTOTAL $498,510 261,025 TOTAL FINANCIAL RESOURCES $5,539,000 2,610,257 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 352,570 ii) Right-of-Way $0 318,555 iii) Construction $5,539,000 1,762,847 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 176,285 TOTAL ESTIMATED COSTS $5,539,000 2,610,257 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Columbus, Franklin County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC01X/CC02X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 352,570.00 $ $ $ B) Right-ofWay $0.00 318,555.00 $ $ $ C) Construction $5,539,000.00 1,762,847.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 176,285.00 $ $ $ G) Total Expenditures $5,539,000.00 2,610,257.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 261,025 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 2,349,232.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,349,232.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,610,257.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxx, City Engineer/Administrator Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 1,700,000 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $11,850,000 - FmHA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 13,550,000 v) OPWC Funds: $498,510 4,376,874 SUBTOTAL $498,510 4,376,874 TOTAL FINANCIAL RESOURCES $5,539,000 17,926,874 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $0 - Other Engineering Services $966,406 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 6,000,000 iii) Construction Costs $5,539,000 9,964,062 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 996,406 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Cuyahoga County, (035-00035), Cuyahoga County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Chagrin & Van Aken Blvd., Xxxxxxxxxxxx Xxxxxx & Xxxxxxxxxx Xx. Xxxxxxxxxxxx, XXX00. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $0 $ $ $ 3) Other Engineering Services $966,406 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 6,000,000 $ $ $ C) Construction Costs $5,539,000.00 9,964,062 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 0 $ $ $ F) Construction Contingencies $0.00 996,406 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 17,926,874 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER AGREEMENT USED PRIOR TO THIS DRAW AS PART OF PAID THIS DRAW USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $4,376,874 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 0 $ $ $ 2) Public Revenues $5,040,490.00 1,700,000 3) Private Revenues $0 $ $ $ J$ $ $ K) Other Revenue Public Revenues 1) ODOT/FHWA ODOT $0.00 11,850,000 $ $ $ 2) OEPA/FmHA $0 3) OEPA $0 4) OWDA $0.00 $ $ $ 30 5) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 506) Other $0.00 $ $ $ K0 L) Total Local and Other Revenue Public Revenues $5,040,490.00 13,550,000 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 121,722 ii) Local Public Revenue Revenues $5,040,490 0 iii) Local Private Revenues iv) Other RevenuePublic Revenues: $0 - ODOT/FHWA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL v) OPWC Funds: - Loan Assistance $5,040,490 - Grant $498,510 SUBTOTAL $498,510 TOTAL FINANCIAL RESOURCES $5,539,000 0 b) PROJECT ESTIMATED COSTS: : i) EngineeringProject Engineering Costs: $0 ii) Right-of-Way Right of Way: $0 iii) Construction Costs $5,539,000 216,975 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 21,697 Statement requesting the disbursement of funds from the OPWC Ohio Public Works Commission (OPWC) pursuant to Section V VI of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission OPWC (the "Director") and Delaware The City of Milford, (025-50176), Clermont County (the "Recipient"), dated 07/01/2020July 1, 2018, for the sole and express purpose of financing the Capital Improvement Project capital improvement project defined and described in Appendix A of the Project Agreement (the "Project") and named and numbered as DQX13. SR 126 Landslide Improvements, CJ26V. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE A) Project Engineering Costs AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ 2) Final Design $0 $ $ $ 3) Construction Administration $0 $ $ $ B) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 216,975 $ $ $ D) Materials Purchased Directly $0.00 0 $ $ $ E) Permits, Advertising, Legal $0.00 0 $ $ $ F) Construction Contingencies $0.00 21,697 $ N/A $ N/A $ G) Total Expenditures $5,539,000.00 $ $ $ FINANCING PROGRESS: N/A (1) AS PER AGREEMENT (2) PRIOR DISBURSED (3) AS PART OF THIS DRAW (4) AS PER PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $116,950 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 121,722 $ $ $ 2) Public Revenues $5,040,490.00 0 $ $ $ 3) Private Revenues $0 $ $ $ J) Other Revenue Public Revenues 1) ODOT/FHWA $0.00 0 $ $ $ 2) OEPA/OWDA OEPA $0.00 0 $ $ $ 3) CDBG OWDA $0.00 0 $ $ $ 4) USDA CDBG $0.00 0 $ $ $ 5) Other $0.00 0 $ $ $ K) Total Local and Other Revenue Public Revenues $5,040,490.00 121,722 $ $ $ LIs this the final request for disbursement of OPWC funds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects project completion at an estimated %. Phone Pursuant to Section VI.B. and VI.C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer of the Recipient, as both are designated in Appendix B of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix C of the Agreement (inclusive of any amendment thereto) Total Financing (H+Kto the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) $5,539,000.00 $ $ $Each item of project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested hereunder is or was necessary in connection with the performance of the project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 700,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 300,000 SUBTOTAL $5,040,490 1,000,000 - Grant $498,510 450,000 - Loan $150,000 SUBTOTAL $498,510 600,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,600,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 175,000 ii) Right-of-Way $0 iii) Construction $5,539,000 1,315,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 110,000 TOTAL ESTIMATED COSTS $5,539,000 1,600,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Willowick, Lake County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CG07W/CG08W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 175,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,315,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 110,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,600,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 600,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 700,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 300,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,000,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,600,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 21,352 iii) Other Revenue: - ODOT/FHWA $0 939,488 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 960,840 - Grant $498,510 320,280 SUBTOTAL $498,510 320,280 TOTAL FINANCIAL RESOURCES $5,539,000 1,281,120 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 106,760 ii) Right-of-Way $0 iii) Construction $5,539,000 1,067,600 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 106,760 TOTAL ESTIMATED COSTS $5,539,000 1,281,120 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CD10W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 106,760.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,067,600.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 106,760.00 $ $ $ G) Total Expenditures $5,539,000.00 1,281,120.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 320,280 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 21,352.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 939,488.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 960,840.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,281,120.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxxx, Bridge Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 525,000 iii) Other Revenue: - ODOT/FHWA $0 250,000 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 775,000 - Grant $498,510 275,000 SUBTOTAL $498,510 275,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,050,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 170,000 ii) Right-of-Way $0 iii) Construction $5,539,000 800,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 80,000 TOTAL ESTIMATED COSTS $5,539,000 1,050,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Xxxxx, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CE24X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 170,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 800,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 80,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,050,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 275,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 525,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 250,000.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 775,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,050,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxx Xxxxxx, Project Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 ii) Local Public Revenue Revenues $5,040,490 678,326 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 678,326 v) OPWC Funds: $498,510 985,000 SUBTOTAL $498,510 985,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,663,326 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $25,000 - Other Engineering Services $25,000 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 iii) Construction Costs $5,539,000 1,465,751 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 1,000 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 146,575 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND The City of Fairfield, (017-25970), Xxxxxx County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS River Rd. Improvements, CJX05. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $25,000 $ $ $ 3) Other Engineering Services $25,000 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,465,751 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 1,000 $ $ $ F) Construction Contingencies $0.00 146,575 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,663,326 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $DATE

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 630,345 iii) Other Revenue: - ODOT/FHWA $0 4,469,715 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 630,345 - Grant $498,510 630,344 SUBTOTAL $498,510 630,344 TOTAL FINANCIAL RESOURCES $5,539,000 5,730,404 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 5,730,404 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 5,730,404 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Sycamore Township, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB05V. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 5,730,404.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 5,730,404.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 630,344 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 630,345.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 4,469,715.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 630,345.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 5,730,404.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. N/A, Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 263,500 ii) Local Public Revenue Revenues $5,040,490 0 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 263,500 v) OPWC Funds: $498,510 3,646,500 SUBTOTAL $498,510 3,646,500 TOTAL FINANCIAL RESOURCES $5,539,000 3,910,000 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $280,000 - Other Engineering Services $280,000 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 200,000 iii) Construction Costs $5,539,000 2,870,000 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 280,000 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Franklin County, (049-00049), Franklin County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Xxxxxx Road/Xxxxx Avenue Intersection Improvement, CCX04. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $280,000 $ $ $ 3) Other Engineering Services $280,000 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 200,000 $ $ $ C) Construction Costs $5,539,000.00 2,870,000 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 0 $ $ $ F) Construction Contingencies $0.00 280,000 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 3,910,000 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER AGREEMENT USED PRIOR TO THIS DRAW AS PART OF PAID THIS DRAW USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $3,646,500 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 263,500 $ $ $ 2) Public Revenues $5,040,490.00 0 3) Private Revenues $0 $ $ $ J$ $ $ K) Other Revenue Public Revenues 1) ODOT/FHWA ODOT $0.00 0 $ $ $ 2) OEPA/FmHA $0 3) OEPA $0 4) OWDA $0.00 $ $ $ 30 5) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 506) Other $0.00 $ $ $ K0 L) Total Local and Other Revenue Public Revenues $5,040,490.00 263,500 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 263,100 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 263,100 - Grant $498,510 1,219,031 - Loan $3,676,676 SUBTOTAL $498,510 4,895,707 TOTAL FINANCIAL RESOURCES $5,539,000 5,158,807 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 596,886 ii) Right-of-Way $0 iii) Construction $5,539,000 4,263,478 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 298,443 TOTAL ESTIMATED COSTS $5,539,000 5,158,807 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Bexley, Franklin County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CC06X/CC07X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 596,886.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 4,263,478.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 298,443.00 $ $ $ G) Total Expenditures $5,539,000.00 5,158,807.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 4,895,707 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 263,100.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 263,100.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 5,158,807.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 70,000 ii) Local Public Revenue Revenues $5,040,490 330,500 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 400,500 v) OPWC Funds: $498,510 599,500 SUBTOTAL $498,510 599,500 TOTAL FINANCIAL RESOURCES $5,539,000 1,000,000 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $70,000 - Other Engineering Services $70,000 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 70,000 iii) Construction Costs $5,539,000 720,000 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the 70,000 STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Franklin County, (049-00049), Franklin County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") and named and numbered as DQX13AND NAMED AND NUMBERED AS Xxxxxxxx Road/Harlem Road Intersection Improvement, CCX02. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $70,000 $ $ $ 3) Other Engineering Services $70,000 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 70,000 $ $ $ C) Construction Costs $5,539,000.00 720,000 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 0 $ $ $ F) Construction Contingencies $0.00 70,000 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,000,000 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $DATE

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 36,000 ii) Local Public Revenue $5,040,490 2,924,894 iii) Other Revenue: - ODOT/FHWA $0 2,126,815 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 5,087,709 - Grant $498,510 400,000 - Loan $400,000 SUBTOTAL $498,510 800,000 TOTAL FINANCIAL RESOURCES $5,539,000 5,887,709 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 670,000 ii) Right-of-Way $0 45,000 iii) Construction $5,539,000 4,925,866 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 550 vi) Construction Contingencies $0 246,293 TOTAL ESTIMATED COSTS $5,539,000 5,887,709 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Athens, Athens County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CR02X/CR03X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 670,000.00 $ $ $ B) Right-ofWay $0.00 45,000.00 $ $ $ C) Construction $5,539,000.00 4,925,866.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 550.00 $ $ $ F) Construction Contingencies $0.00 246,293.00 $ $ $ G) Total Expenditures $5,539,000.00 5,887,709.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 800,000 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 36,000.00 $ $ $ 2) Public Revenues $5,040,490.00 2,924,894.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 2,126,815.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 5,087,709.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 5,887,709.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request.

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,136,775 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 1,136,774 SUBTOTAL $5,040,490 2,273,549 - Grant $498,510 2,200,000 SUBTOTAL $498,510 2,200,000 TOTAL FINANCIAL RESOURCES $5,539,000 4,473,549 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 765,616 ii) Right-of-Way $0 iii) Construction $5,539,000 3,370,848 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 337,085 TOTAL ESTIMATED COSTS $5,539,000 4,473,549 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Cuyahoga County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA02W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 765,616.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,370,848.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 337,085.00 $ $ $ G) Total Expenditures $5,539,000.00 4,473,549.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 2,200,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,136,775.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 1,136,774.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,273,549.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 4,473,549.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx Xxxxxx, Senior Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 2,336,540 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 2,336,540 - Grant $498,510 3,504,810 SUBTOTAL $498,510 3,504,810 TOTAL FINANCIAL RESOURCES $5,539,000 5,841,350 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 86,330 ii) Right-of-Way $0 iii) Construction $5,539,000 5,755,020 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 5,841,350 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Cleveland, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA02X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 86,330.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 5,755,020.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 5,841,350.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 3,504,810 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 2,336,540.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,336,540.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 5,841,350.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,784,466 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 1,546,746 SUBTOTAL $5,040,490 3,331,212 - Grant $498,510 832,803 SUBTOTAL $498,510 832,803 TOTAL FINANCIAL RESOURCES $5,539,000 4,164,015 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 974,015 ii) Right-of-Way $0 iii) Construction $5,539,000 2,900,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 290,000 TOTAL ESTIMATED COSTS $5,539,000 4,164,015 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA13X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 974,015.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 2,900,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 290,000.00 $ $ $ G) Total Expenditures $5,539,000.00 4,164,015.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 832,803 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,784,466.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 1,546,746.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 3,331,212.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 4,164,015.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx Xxxxxx, Senior Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 434,000 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 5,028,000 - CDBG $0 - USDA $0 - Other $0 250,000 SUBTOTAL $5,040,490 5,712,000 - Grant $498,510 950,000 SUBTOTAL $498,510 950,000 TOTAL FINANCIAL RESOURCES $5,539,000 6,662,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 1,103,000 ii) Right-of-Way $0 iii) Construction $5,539,000 5,035,700 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 20,000 vi) Construction Contingencies $0 503,300 TOTAL ESTIMATED COSTS $5,539,000 6,662,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Village of West Farmington, Trumbull County (the "Recipient"), dated 07/01/202001/14/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF28W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 1,103,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 5,035,700.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 20,000.00 $ $ $ F) Construction Contingencies $0.00 503,300.00 $ $ $ G) Total Expenditures $5,539,000.00 6,662,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 950,000 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 434,000.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 5,028,000.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 250,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 5,712,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 6,662,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors will be paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxx, Associate Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 797,255 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 797,255 - Grant $498,510 149,500 - Loan $149,500 SUBTOTAL $498,510 299,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,096,255 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 148,000 ii) Right-of-Way $0 iii) Construction $5,539,000 787,712 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 3,000 vi) Construction Contingencies $0 157,543 TOTAL ESTIMATED COSTS $5,539,000 1,096,255 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Village of Ottawa Hills, Xxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CL03X/CL04X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 148,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 787,712.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 3,000.00 $ $ $ F) Construction Contingencies $0.00 157,543.00 $ $ $ G) Total Expenditures $5,539,000.00 1,096,255.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 299,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 797,255.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 797,255.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,096,255.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx Xxxxxxxx, Village Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 3,000,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 100,000 - USDA $0 - Other $0 SUBTOTAL $5,040,490 3,100,000 - Grant $498,510 750,000 - Loan $866,850 SUBTOTAL $498,510 1,616,850 TOTAL FINANCIAL RESOURCES $5,539,000 4,716,850 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 450,000 ii) Right-of-Way $0 iii) Construction $5,539,000 3,878,500 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 500 vi) Construction Contingencies $0 387,850 TOTAL ESTIMATED COSTS $5,539,000 4,716,850 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Lakewood, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA07X/CA15X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 450,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,878,500.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 500.00 $ $ $ F) Construction Contingencies $0.00 387,850.00 $ $ $ G) Total Expenditures $5,539,000.00 4,716,850.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,616,850 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 3,000,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 100,000.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 3,100,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 4,716,850.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 46,722 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 955,200 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,001,922 - Grant $498,510 600,000 - Loan $973,570 SUBTOTAL $498,510 1,573,570 TOTAL FINANCIAL RESOURCES $5,539,000 2,575,492 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 2,575,492 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 2,575,492 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CO03W/CO04W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 2,575,492.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 2,575,492.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,573,570 $ $ $ I) Local Share 1) In-kind Contributions $0.00 46,722.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 955,200.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,001,922.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,575,492.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxx Xxxxxx, Xxxxxxx County Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 25,450 iii) Other Revenue: - ODOT/FHWA $0 1,474,550 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,500,000 - Grant $498,510 500,000 SUBTOTAL $498,510 500,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,000,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 135,458 ii) Right-of-Way $0 iii) Construction $5,539,000 1,693,220 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 2,000 vi) Construction Contingencies $0 169,322 TOTAL ESTIMATED COSTS $5,539,000 2,000,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Dayton, Xxxxxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CD04W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 135,458.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,693,220.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 2,000.00 $ $ $ F) Construction Contingencies $0.00 169,322.00 $ $ $ G) Total Expenditures $5,539,000.00 2,000,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 500,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 25,450.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 1,474,550.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,500,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,000,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxxx, Public Works Deputy Director Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,271,250 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,271,250 - Grant $498,510 423,750 SUBTOTAL $498,510 423,750 TOTAL FINANCIAL RESOURCES $5,539,000 1,695,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 239,820 ii) Right-of-Way $0 iii) Construction $5,539,000 1,320,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 3,180 vi) Construction Contingencies $0 132,000 TOTAL ESTIMATED COSTS $5,539,000 1,695,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Lakewood, Cuyahoga County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA01X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 239,820.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,320,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 3,180.00 $ $ $ F) Construction Contingencies $0.00 132,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,695,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 423,750 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,271,250.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,271,250.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,695,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx Xxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 500,312 - CDBG $0 630,000 - USDA $0 - Other $0 250,000 SUBTOTAL $5,040,490 1,380,312 - Grant $498,510 750,000 SUBTOTAL $498,510 750,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,130,312 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 182,292 ii) Right-of-Way $0 25,000 iii) Construction $5,539,000 1,738,200 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 11,000 vi) Construction Contingencies $0 173,820 TOTAL ESTIMATED COSTS $5,539,000 2,130,312 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Trumbull County (the "Recipient"), dated 07/01/202002/26/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF09W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 182,292.00 $ $ $ B) Right-ofWay $0.00 25,000.00 $ $ $ C) Construction $5,539,000.00 1,738,200.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 11,000.00 $ $ $ F) Construction Contingencies $0.00 173,820.00 $ $ $ G) Total Expenditures $5,539,000.00 2,130,312.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 750,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 500,312.00 $ $ $ 3) CDBG $0.00 630,000.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 250,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,380,312.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,130,312.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx X. Xxxxxxxxx, Controller Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 79,609 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 1,037,000 - CDBG $0 - USDA $0 - Other $0 101,466 SUBTOTAL $5,040,490 1,218,075 - Grant $498,510 492,500 - Loan $492,500 SUBTOTAL $498,510 985,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,203,075 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 185,000 ii) Right-of-Way $0 iii) Construction $5,539,000 1,878,268 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 139,807 TOTAL ESTIMATED COSTS $5,539,000 2,203,075 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CD31W/CD32W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 185,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,878,268.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 139,807.00 $ $ $ G) Total Expenditures $5,539,000.00 2,203,075.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 985,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 79,609.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 1,037,000.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 101,466.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,218,075.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,203,075.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xx Xxxxxxxx, Senior Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 3,148,608 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 3,148,608 SUBTOTAL $5,040,490 6,297,216 - Grant $498,510 6,229,948 SUBTOTAL $498,510 6,229,948 TOTAL FINANCIAL RESOURCES $5,539,000 12,527,164 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 2,402,932 ii) Right-of-Way $0 iii) Construction $5,539,000 9,265,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 859,232 TOTAL ESTIMATED COSTS $5,539,000 12,527,164 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Cuyahoga County (the "Recipient"), dated 07/01/202009/19/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CA07W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 2,402,932.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 9,265,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 859,232.00 $ $ $ G) Total Expenditures $5,539,000.00 12,527,164.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 6,229,948 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 3,148,608.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 3,148,608.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 6,297,216.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 12,527,164.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx Xxxxxx, Senior Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 0 - Grant $498,510 977,175 - Loan $977,175 SUBTOTAL $498,510 1,954,350 TOTAL FINANCIAL RESOURCES $5,539,000 1,954,350 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 153,000 ii) Right-of-Way $0 iii) Construction $5,539,000 1,801,350 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,954,350 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Reading, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB30X/CB31X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 153,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,801,350.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,954,350.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,954,350 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 0.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,954,350.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxx X. Xxxxxxxx, Project Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 20,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 20,000 - Grant $498,510 500,000 - Loan $500,000 SUBTOTAL $498,510 1,000,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,020,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 60,000 ii) Right-of-Way $0 iii) Construction $5,539,000 880,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 80,000 TOTAL ESTIMATED COSTS $5,539,000 1,020,000 Statement requesting the disbursement of funds from the OPWC Ohio Small Government Capital Improvements Program (OSGCIP) pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director Administrator of the Ohio Public Works Commission OSGCIP (the "DirectorAdministrator") and Delaware Village of Coldwater, Xxxxxx County (the "Recipient"), dated 07/01/202008/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CT68X/CT69X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 60,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 880,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 80,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,020,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,000,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 20,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 20,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,020,000.00 $ $ $$ Second Street Reconstruction I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxx, Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OSGCIP in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OSGCIP; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 620,198 iii) Other Revenue: - ODOT/FHWA $0 346,650 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 966,848 - Grant $498,510 690,000 SUBTOTAL $498,510 690,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,656,848 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 228,531 ii) Right-of-Way $0 iii) Construction $5,539,000 1,428,317 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,656,848 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Youngstown, Mahoning County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF31X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 228,531.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,428,317.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,656,848.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 690,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 620,198.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 346,650.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 966,848.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,656,848.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 768,110 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 768,110 - Grant $498,510 768,110 SUBTOTAL $498,510 768,110 TOTAL FINANCIAL RESOURCES $5,539,000 1,536,220 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,536,220 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,536,220 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Village of Indian Hill, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB19X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,536,220.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,536,220.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 768,110 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 768,110.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 768,110.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,536,220.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxxxxx X. Xxxx-Xxxxxx, Project Manager Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 122,000 ii) Local Public Revenue Revenues $5,040,490 562,930 iii) Local Private Revenues $0 iv) Other RevenuePublic Revenues: - ODOT/FHWA ODOT $0 - OEPA/FmHA $0 - OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant 684,930 v) OPWC Funds: $498,510 658,070 SUBTOTAL $498,510 658,070 TOTAL FINANCIAL RESOURCES $5,539,000 1,343,000 b) PROJECT ESTIMATED COSTS: :i) EngineeringProject Engineering Costs: - Preliminary Engineering $0 - Final Design $73,500 - Other Engineering Services $54,500 ii) Acquisition Expenses: - Land $0 - Right-of-Way $0 iii) Construction Costs $5,539,000 1,212,000 iv) Materials Purchased Directly Equipment Costs $0 v) Permits, Advertising, Legal Other Direct Expenses $0 3,000 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the STATEMENT REQUESTING THE DISBURSEMENT OF FUNDS FROM THE OPWC pursuant to Section V of the Project Agreement PURSUANT TO SECTION 6 OF THE PROJECT AGREEMENT (the "Agreement") executed between the Director of the Ohio Public Works Commission EXECUTED BETWEEN THE DIRECTOR OF THE OHIO PUBLIC WORKS COMMISSION (the "Director") and Delaware AND Springfield Township, (095-74123), Xxxxx County (the "Recipient"), dated 07/01/2020DATED July 1, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix 2012, FOR THE SOLE AND EXPRESS PURPOSE OF FINANCING THE CAPITAL IMPROVEMENT PROJECT DEFINED AND DESCRIBED IN APPENDIX A of the Agreement OF THE AGREEMENT (the "Project") AND NAMED AND NUMBERED AS Kieswelter, Jade Estates and named and numbered as DQX13Spring Valley Roads, CLX02. EXPENDITURES PROGRESS: (1) (2) (3) (4) A) Project Engineering Costs AS PER AGREEMENT PAID PRIOR TO THIS DRAW AS PART OF THIS DRAW PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ B2) Final Design $73,500 $ $ $ 3) Other Engineering Services $54,500 $ $ $ 1) Land $0 $ $ $ 2) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,212,000 $ $ $ D) Materials Purchased Directly Equipment Costs $0.00 0 $ $ $ E) Permits, Advertising, Legal Other Direct Expenses $0.00 3,000 $ $ $ F) Construction Contingencies $0.00 0 $ N/A $ N/A $ N/A G) Total Expenditures Totals $5,539,000.00 1,343,000 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER USED PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 $ $ $DATE

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 81,500 ii) Local Public Revenue Revenues $5,040,490 581,319 iii) Local Private Revenues iv) Other RevenuePublic Revenues: $0 - ODOT/FHWA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 - Grant $498,510 SUBTOTAL $498,510 TOTAL FINANCIAL RESOURCES $5,539,000 v) OPWC Funds: b) PROJECT ESTIMATED COSTS: : i) EngineeringProject Engineering Costs: $0 ii) Right-of-Way $0 iii) Construction Costs $5,539,000 1,324,319 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V 6 of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Xxxxx County, (001-00001), Xxxxx County (the "Recipient"), dated 07/01/2020July 1, 2015, for the sole and express purpose of financing the Capital Improvement Project capital improvement project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. County, Xxxxxxxx & Xxxxxxx Xxxx/Xxxxxx Xxxxxxxxxxxx, XX00X/XX00X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PAID PRIOR AS PART OF PAID TO DATE A) Project Engineering Costs AGREEMENT DISBURSED TO THIS DRAW THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 0 $ $ $ 2) Final Design $500 $ $ $ 3) Construction Administration $1,000 $ $ $ B) Right-ofWay of-Way $0.00 0 $ $ $ C) Construction Costs $5,539,000.00 1,324,319 $ $ $ D) Materials Purchased Directly $0.00 0 $ $ $ E) Permits, Advertising, Legal $0.00 0 $ $ $ F) Construction Contingencies $0.00 0 $ N/A $ N/A $ G) Total Expenditures $5,539,000.00 $ $ $ FINANCING PROGRESS: N/A (1) AS PER AGREEMENT (2) USED PRIOR TO THIS DRAW (3) AS PART OF THIS DRAW (4) AS PER PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 81,500 $ $ $ J) Other Revenue Public Revenues 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 0 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 0 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 1,963,500 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,963,500 - Grant Loan $498,510 262,500 SUBTOTAL $498,510 262,500 TOTAL FINANCIAL RESOURCES $5,539,000 2,226,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 223,920 ii) Right-of-Way $0 100,000 iii) Construction $5,539,000 1,492,800 iv) Materials Purchased Directly $0 250,000 v) Permits, Advertising, Legal $0 10,000 vi) Construction Contingencies $0 149,280 TOTAL ESTIMATED COSTS $5,539,000 2,226,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Northwestern Water and Sewer District (Dist 5), Wood County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CE36X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 223,920.00 $ $ $ B) Right-ofWay $0.00 100,000.00 $ $ $ C) Construction $5,539,000.00 1,492,800.00 $ $ $ D) Materials Purchased Directly $0.00 250,000.00 $ $ $ E) Permits, Advertising, Legal $0.00 10,000.00 $ $ $ F) Construction Contingencies $0.00 149,280.00 $ $ $ G) Total Expenditures $5,539,000.00 2,226,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 262,500 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 0.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 1,963,500.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,963,500.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,226,000.00 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 256,450 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 256,450 - USDA $0 - Other $0 SUBTOTAL $5,040,490 512,900 - Grant $498,510 602,100 SUBTOTAL $498,510 602,100 TOTAL FINANCIAL RESOURCES $5,539,000 1,115,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,062,268 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 52,732 TOTAL ESTIMATED COSTS $5,539,000 1,115,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Xxxxxx, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CF20X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,062,268.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 52,732.00 $ $ $ G) Total Expenditures $5,539,000.00 1,115,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 602,100 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 256,450.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 256,450.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 512,900.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,115,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxx Xxxxxxx, Director of Engineering Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,031,325 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 687,550 SUBTOTAL $5,040,490 1,718,875 - Grant $498,510 1,718,875 SUBTOTAL $498,510 1,718,875 TOTAL FINANCIAL RESOURCES $5,539,000 3,437,750 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 3,125,227 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 312,523 TOTAL ESTIMATED COSTS $5,539,000 3,437,750 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Sycamore Township, Xxxxxxxx County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB15W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 3,125,227.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 312,523.00 $ $ $ G) Total Expenditures $5,539,000.00 3,437,750.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,718,875 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,031,325.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 687,550.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,718,875.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 3,437,750.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx Xxxxxxx, Maintenance Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 656,900 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 656,900 - Grant $498,510 500,000 - Loan $150,000 SUBTOTAL $498,510 650,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,306,900 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 140,000 ii) Right-of-Way $0 iii) Construction $5,539,000 1,060,800 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 106,100 TOTAL ESTIMATED COSTS $5,539,000 1,306,900 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Mentor, Lake County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CG53X/CG54X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 140,000.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,060,800.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 106,100.00 $ $ $ G) Total Expenditures $5,539,000.00 1,306,900.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 650,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 656,900.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 656,900.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,306,900.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx X. Xxxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,150,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL $5,040,490 1,150,000 - Grant $498,510 1,150,000 SUBTOTAL $498,510 1,150,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,300,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 2,270,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 30,000 TOTAL ESTIMATED COSTS $5,539,000 2,300,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Cincinnati, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB11X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 2,270,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 30,000.00 $ $ $ G) Total Expenditures $5,539,000.00 2,300,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 1,150,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,150,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 1,150,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,300,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 1,623,800 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 583,700 SUBTOTAL $5,040,490 2,207,500 - Grant $498,510 500,000 - Loan $150,000 SUBTOTAL $498,510 650,000 TOTAL FINANCIAL RESOURCES $5,539,000 2,857,500 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 306,100 ii) Right-of-Way $0 iii) Construction $5,539,000 2,319,500 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 231,900 TOTAL ESTIMATED COSTS $5,539,000 2,857,500 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Mentor, Lake County (the "Recipient"), dated 07/01/202007/01/2019, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CG57W/CG58W. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 306,100.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 2,319,500.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 231,900.00 $ $ $ G) Total Expenditures $5,539,000.00 2,857,500.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 650,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 1,623,800.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 583,700.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 2,207,500.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 2,857,500.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxxxx X. Xxxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 ii) Local Public Revenue $5,040,490 539,000 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 161,000 SUBTOTAL $5,040,490 700,000 - Grant $498,510 700,000 SUBTOTAL $498,510 700,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,400,000 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 ii) Right-of-Way $0 iii) Construction $5,539,000 1,365,000 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 35,000 TOTAL ESTIMATED COSTS $5,539,000 1,400,000 Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware City of Cincinnati, Xxxxxxxx County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CB26X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,365,000.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 35,000.00 $ $ $ G) Total Expenditures $5,539,000.00 1,400,000.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 700,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 539,000.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 161,000.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 700,000.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,400,000.00 $ $ $$ I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request. Xxx Xxxxxxxx, City Engineer Date Phone Pursuant to Section V. B. and V. C. of the Agreement, the undersigned Chief Executive Officer and Chief Fiscal Officer, as both are designated in Appendix A of the Agreement, hereby request the Director to disburse financial assistance moneys made available to Project in Appendix B of the Agreement (inclusive of any amendment thereto) to the payee as identified below in the amount so indicated which amount equals the product of the Disbursement Ratio and the dollar value of the attached cost documentation which was properly billed to the Recipient in exclusive connection with the performance of the Project. The undersigned further certify that: 1) Each item of Project cost documentation attached hereto is properly payable by the OPWC in accordance with the terms and conditions of the Agreement, and none of the items for which payment is requested has formed the basis of any payment heretofore made from the OPWC; 2) Each item for which payment is requested is or was necessary in connection with the performance of the Project;

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project as defined and described in Appendix A of this Agreement to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind kind Contributions $0 123,500 ii) Local Public Revenue Revenues $5,040,490 376,500 iii) Local Private Revenues iv) Other RevenuePublic Revenues: $0 - ODOT/FHWA $0 - OEPA/OEPA $0 - OWDA $0 - CDBG $0 - USDA $0 - Other $0 SUBTOTAL v) OPWC Funds: - Loan Assistance $5,040,490 - Grant $498,510 SUBTOTAL $498,510 TOTAL FINANCIAL RESOURCES $5,539,000 0 b) PROJECT ESTIMATED COSTS: : i) EngineeringProject Engineering Costs: ii) Right of Way: $0 ii) Right-of-Way $0 1,300 iii) Construction Costs $5,539,000 704,250 iv) Materials Purchased Directly $0 273,200 v) Permits, Advertising, Legal $0 250 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 Statement requesting the disbursement of funds from the OPWC Ohio Public Works Commission (OPWC) pursuant to Section V VI of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission OPWC (the "Director") and Delaware Richland County, (139-00139), Richland County (the "Recipient"), dated 07/01/2020July 1, 2016, for the sole and express purpose of financing the Capital Improvement Project capital improvement project defined and described in Appendix A of the Project Agreement (the "Project") and named and numbered as DQX13. Xxxxxxxx Falls Road Bridge & Other Improvements, CP13T. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PAID PRIOR AS PART OF PAID TO DATE A) Project Engineering Costs AGREEMENT DISBURSED TO THIS DRAW THIS DRAW (Column 2 + 3) A1) Preliminary Engineering $0.00 3,000 $ $ $ 2) Final Design $15,000 $ $ $ 3) Construction Administration $3,000 $ $ $ B) Right-ofWay of-Way $0.00 1,300 $ $ $ C) Construction Costs $5,539,000.00 704,250 $ $ $ D) Materials Purchased Directly $0.00 273,200 $ $ $ E) Permits, Advertising, Legal $0.00 250 $ $ $ F) Construction Contingencies $0.00 0 $ N/A $ N/A $ G) Total Expenditures $5,539,000.00 $ $ $ FINANCING PROGRESS: N/A (1) AS PER AGREEMENT (2) USED PRIOR TO THIS DRAW (3) AS PART OF THIS DRAW (4) AS PER PRIOR AS PART OF PAID USED TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 $ $ $ I) Local Share Share 1) In-kind Contributions $0.00 $ $ $ 2) Public Revenues $5,040,490.00 123,500 $ $ $ J) Other Revenue Public Revenues 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 0 $ $ $

PROJECT FINANCING AND EXPENSES SCHEME. The Recipient further designates the Project's estimated financial resources and estimated costs certified to the OPWC under this Agreement for the Project to consist of the following components: a) PROJECT FINANCIAL RESOURCES: i) Local In-Kind Contributions $0 12,550 ii) Local Public Revenue $5,040,490 552,825 iii) Other Revenue: - ODOT/FHWA $0 - OEPA/OWDA $0 - CDBG $0 - USDA $0 - Other $0 12,750 SUBTOTAL $5,040,490 578,125 - Grant $498,510 585,000 SUBTOTAL $498,510 585,000 TOTAL FINANCIAL RESOURCES $5,539,000 1,163,125 b) PROJECT ESTIMATED COSTS: i) Engineering: $0 2,500 ii) Right-of-Way $0 iii) Construction $5,539,000 1,160,625 iv) Materials Purchased Directly $0 v) Permits, Advertising, Legal $0 vi) Construction Contingencies $0 TOTAL ESTIMATED COSTS $5,539,000 1,163,125 Ohio Public Works Commission Disbursement Request Form and Certification Statement requesting the disbursement of funds from the OPWC pursuant to Section V of the Project Agreement (the "Agreement") executed between the Director of the Ohio Public Works Commission (the "Director") and Delaware Adams County (the "Recipient"), dated 07/01/2020, for the sole and express purpose of financing the Capital Improvement Project defined and described in Appendix A of the Agreement (the "Project") and named and numbered as DQX13. CO02X. EXPENDITURES PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) A) Engineering $0.00 2,500.00 $ $ $ B) Right-ofWay $0.00 $ $ $ C) Construction $5,539,000.00 1,160,625.00 $ $ $ D) Materials Purchased Directly $0.00 $ $ $ E) Permits, Advertising, Legal $0.00 $ $ $ F) Construction Contingencies $0.00 $ $ $ G) Total Expenditures $5,539,000.00 1,163,125.00 $ $ $ FINANCING PROGRESS: (1) (2) (3) (4) AS PER PRIOR AS PART OF PAID TO DATE AGREEMENT DISBURSED THIS DRAW (Column 2 + 3) H) OPWC Funds 498,510 585,000 $ $ $ I) Local Share 1) In-kind Contributions $0.00 12,550.00 $ $ $ 2) Public Revenues $5,040,490.00 552,825.00 $ $ $ J) Other Revenue 1) ODOT/FHWA $0.00 $ $ $ 2) OEPA/OWDA $0.00 $ $ $ 3) CDBG $0.00 $ $ $ 4) USDA $0.00 $ $ $ 5) Other $0.00 12,750.00 $ $ $ K) Total Local and Other Revenue $5,040,490.00 578,125.00 $ $ $ L) Total Financing (H+K) $5,539,000.00 1,163,125.00 $ $ $$ OPWC Control No.: CO02X Disbursement Request # If this is a final request (to be marked on top of page 3) or if this disbursement uses the remainder of your assistance, your Project file will be closed upon processing this request. As described in Appendix B of the Project Agreement, your minimum Percentage Contribution is 50% of the total Project cost. AUTHORIZED CERTIFICATIONS Changes to Project officials must be submitted in writing. PROJECT MANAGER CERTIFICATION: I hereby certify that the work items invoiced and included herein are exclusively associated with the Project, have been completed in a satisfactory manner, and are otherwise in accord with the terms and conditions of the Agreement. This request reflects Project completion at an estimated %. I certify that the information under this Disbursement Request Form and Certification is true and accurate, and that the work has been completed in accordance with the terms of the Agreement, including payment of the applicable prevailing wage rates. By signing below, I certify that the material suppliers, contractors and subcontractors have been paid in full for work performed and materials supplied pursuant to this Request.