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Exhibit E -- Page 1 of 1 <br /> <br />CDBG LOAN AGREEMENT <br />BETWEEN THE CITY OF SAN LEANDRO AND <br />BUILDING FUTURES FOR WOMEN AND CHILDREN <br />EXHIBIT E <br />FORM OF REQUISITION – CDBG Program <br /> <br />Requisition No. _____ <br />Participant’s Name: ____________________ <br />Property Address: ____________________ <br /> ____________________ <br /> San Leandro, CA _____ <br /> Reference is made to that certain Loan Agreement, dated as of ____________, 2019 (the “Agreement”), <br />between the City of San Leandro, a public body, corporate and politic (“City”) and Cornerstone Community <br />Development Corp. DBA Building Futures with Women and Children, a California nonprofit corporation <br />(“Participant”) pursuant to which City agreed to provide a loan of funds in the maximum amount of One Hundred Forty <br />Three Thousand Seven Hundred Twenty Five Dollars ($143,725) pursuant to the Community Development Block Grant <br />(CDBG) Program. Capitalized terms used and not otherwise defined shall have the meanings set forth in the <br />Agreement. <br /> The Participant requests a disbursement of funds in the amount of $________ for payment of reimbursable <br />costs for the Project in accordance with the provisions of the Agreement. The supporting documents (invoices, receipts, <br />billing statements) attached to this requisition are true, complete and correct copies of original documents provided by <br />third parties for work authorized by the Agreement. An itemization of costs is as follows: <br /> <br />Description of Improvement Amount <br /> <br />1. $________ <br />2. $________ <br />3. $________ <br /> <br /> Total $___________ <br /> <br /> The disbursement of the amount specified above, when added to all previous disbursements of funds for the <br />Project, will total the sum of $________ of City funds provided for the Project. The balance of Loan funds available <br />after disbursement of funds requested pursuant to this Requisition is $______________. <br /> <br /> The undersigned hereby certifies that the statements set forth in this Requisition are true, complete and <br />correct, and that the disbursement of funds requested hereby conforms to the requirements of the Agreement. <br /> <br />Dated: ________________, 20__ <br /> <br />_______________________________ <br />[Authorized agent of the Participant] <br /> <br /> <br />Approved: <br /> <br />_______________________________ Date: ______________ <br />Authorized Representative of City <br />386