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DRAFT—111212020 EXHIBIT C FORM OF WRITTEN REQUISITION No. (For Cost of Work) To: City of Lakewood, Ohio Attention: Subject: Written Requisition for Costs of Development pursuant to the terms of the Service Agreement dated , 2021 (the "Agreement"), by and between the City of Lakewood, Ohio, and JDSI VODW, LLC (the "Developer"). You are hereby requested to approve the amount of $ as Cost of the Development for the purposes set forth in Item I attached hereto. Unless otherwise defined herein, all capitalized terms set forth but not defined in this Written Requisition have the respective meanings assigned to them in the Agreement. The undersigned authorized representative of the Developer does hereby certify on behalf of the Developer that: I have read the Agreement and definitions relating thereto and have reviewed appropriate records and documents relating to the matters covered by this Written Requisition; The disbursement herein requested is for an obligation properly incurred, is a proper charge as a Cost of the Development (as defined in the Agreement), and has not been the basis of any previous reimbursement request; The Developer is in material compliance with all provisions and requirements of the Agreement and the Development Agreement; The reimbursement requested hereby does not include any amount which is being retained under any holdbacks or retainages provided for in any applicable agreement; The Developer has, or the appropriate parties on the Developer's behalf has, asserted its entitlement to all available manufacturer's warranties to date upon acquisition of possession of or title to the Development or any part thereof which warranties have vested in the Developer; The Developer certifies that (i) there is not any attested account claim from any subcontractor, material supplier or laborer who has performed labor or work or has furnished materials for the Development for which reimbursement is requested pursuant to this Written Requisition; or (ii) has provided security discharging any known attested account claims. EXECUTED this day of , 202_. M Printed: Title: