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