Item 3 - URA/Design Fin. Agr - Laserfiche WebLink

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Exhibit C - Reimbursement Certificate REIMBURSEMENT CERTIFICATE NO. FOR AGREEMENT TO FINANCE DESIGN COSTS OF PATTERSON STREET UNDERPASS TO: McKenzie-Willamette Medical Center Wire Instructions: [insert address] Bank: Address: ABA: Account Name: Account Number: Reference: Patterson Street Underpass Reimbursement On behalf of the City of Eugene, Oregon (the "City"), I hereby certify that: 1. This reimbursement certificate is submitted pursuant to the Agreement to Finance Design Costs of Patterson Street Underpass that is dated as of___, 2004, and is signed by McKenzie-Willamette Medical Center, the Urban Renewal Agency of the City of Eugene, Oregon, and the City (the "Agreement"). I am authorized to request this reimbursement under the Agreement and make the representations on behalf of the City that are included in this reimbursement certificate. 2. The City hereby certifies that it is entitled to reimbursement from McKenzie- Willamette Medical Center pursuant to the Agreement for design costs of the Patterson Street underpass that the City has previously paid in the amount of $ 3. McKenzie-Willamette Medical Center has not paid the City for any of costs described in this reimbursement certificate. 4. The costs of the Patterson Street underpass for which the City is seeking reimbursement in this certificate are: [insert brief description of costs] Dated this __ day of _, 20__ CITY OF EUGENE, OREGON By: Authorized Officer Exhibit C - Reimbursement Certificate