Minutes - Jan. 9, 2012 Regular Meeting

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El 0 EXHIBIT A TO LOCAL GOVERNMENT GRANT AGREEMENT LOCAL GOVERNMENT DISBURSEMENT REQUEST AND CERTIFICATION Project No. 2011 -7666 County of Lee (the "Local Government ") hereby requests a disbursement in the amount of dollar amount] [spell out from the North Carolina Department of Commerce (the "DOC "), pursuant to that certain Company Performance Agreement between the Local Government, Zurn Industries, LLC and Rexnord LLC, dated as of October 14, 2011 (the "CPA "), and that certain Local Government Grant Agreement between the Local Government and the DOC, dated as of October 14, 2011 (the "LGGA," and, together with the CPA, the "Agreements "). All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Agreements. The Local Government hereby certifies to the DOC that it: (i) has provided funds and/or resources for the Project pursuant to the Local Government application to the DOC and the terms of the LGGA, in the amount of ($ ), an amount that is at least equal to the amount of the disbursements that have been requested under the LGGA; (ii) has provided such funds and/or resources in the following form: (iii) has attached true and correct copy of documents evidencing its expenditure of the amount specified in (ii) above for the purposes specified above; (iv) will submit proof of receipt, deposit, and proper disbursement of the disbursed DOC funds, to the DOC, within thirty (30) days; and (v) it is in compliance with all of the terms and conditions of the LGGA, and affirms the representations, warranties, and covenants contained therein; and (vi) to its best knowledge and belief, the Company's Disbursement Request accompanying this certification is accurate, the Company is eligible to receive funds from the Grant in the amount specified herein, under the One NC Loral Gov Disbursement Request Turn Industries, LLC Lee County