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EXHIBIT C <br />FORM OF WRITTEN REQUISITION <br />No. <br />(For Cost of Work) <br />To: City of Lakewood, Ohio <br />Attention: <br />Subject: Written Requisition for Costs of Development pursuant to the terms of the Service Agreement dated March <br />, 2022 (the "Agreement"), by and between the City of Lakewood, Ohio, and WEST 117 DEVELOPMENT LLC, <br />(the "West 117 Developer"), WEST 117 DEVELOPMENT FIELDHOUSE LLC, (the "Fieldhouse Developer"), and <br />WEST 117 DEVELOPMENT PHANTASY LLC (the "Phantasy Developer," and together with the West 117 <br />Developer and the Fieldhouse Developer, the "Developers") <br />You are hereby requested to approve the amount of $ as Cost of the Development for the purposes <br />set forth in Item I attached hereto. Unless otherwise defined herein, all capitalized terms set forth but not defined in <br />this Written Requisition have the respective meanings assigned to them in the Agreement. <br />The undersigned authorized representative of the West 117 Developer does hereby certify on behalf of the <br />Developer that: <br />I have read the Agreement and definitions relating thereto and have reviewed appropriate records and <br />documents relating to the matters covered by this Written Requisition; <br />The disbursement herein requested is for an obligation properly incurred, is a proper charge as a Cost of the <br />Development (as defined in the Agreement), and has not been the basis of any previous reimbursement request; <br />The Developers are in material compliance with all provisions and requirements of the Agreement and the <br />Development Agreement; <br />The reimbursement requested hereby does not include any amount which is being retained under any <br />holdbacks or retainages provided for in any applicable agreement; <br />The Developers have, or the appropriate parties on the Developer's behalf has, asserted its entitlement to all <br />available manufacturer's warranties to date upon acquisition of possession of or title to the Development or any part <br />thereof which warranties have vested in the Developers; <br />The Developers certify that (i) there is not any attested account claim from any subcontractor, material <br />supplier or laborer who has performed labor or work or has furnished materials for the Development for which <br />reimbursement is requested pursuant to this Written Requisition; or (ii) Developers have provided security discharging <br />any known attested account claims. <br />EXECUTED this day of <br />