Certification Form with Assignment
Date
Agency Name
Address
City, State Zip
Re:Contract No. ______between
______(State Agency)
and ______(Supplier),
with ______(Lender)
as the State’s designated Lender
Dear ______:
This is to inform you that all rights, title and interest of Lender in and to the Contract referenced above, including the Assets provided thereunder and the right to receive payments due thereunder, have been assigned by Lender to ______(“Assignee”). You are further informed that: (a) Lender [has] [has not] delegated to Assignee Lender’s obligation to act as registration agent and maintain record of assignments as provided in Section X.A. of the applicable Alpha Plan; and (b) Lender [has] [has not] retained servicing with respect to the Contract. If Lender has not retained servicing, the State’s signature below evidences that the State has received evidence of the consent of GS $Mart to such assignment of the Contract.
All payments and notices in connection with the Contract are to be sent to:
Assignee______
Address______
City, State, Zip______
with a copy of any notices to Lender if Lender has retained servicing. The terms of the Contract provide that the Supplier shall continue to perform all performance obligations and duties under the Contract and Assignee shall not be responsible to perform any such obligations.
Lender has agreed that the State shall have no continuing disclosure obligation under S.E.C. Rule 15c212, and therefore agrees to comply with the requirements for exemption from the Rule set forth in Section 15c212(d)(1)(i).
Pursuant to the Contract, the State hereby certifies (1)that the Assets described in the Contract have been delivered to the State, have been inspected, have been found to be in conformance with the Contract and in good working order and are therefore fully and finally accepted by the State for all purposes of the Contract, and (2)the Date of Acceptance for such Assets is ______, 20__.
The State is selfinsured as required in the Contract.
The State further certifies, and the undersigned hereby represents, that the Assets described in the Contract are essential to the State’s obligation to perform the following functions and that the need is not temporary or expected to diminish in the foreseeable future. Specifically such Assets were selected by the State to be used for the following purposes as indicated below or on the attached page(s):
______
______
By accepting such assignment as evidenced below, Assignee (a) certifies to the State that Assignee is a Permitted Assignee (as such term is defined in the applicable Alpha Plan); and (b) agrees to provide to the State certification of Assignee’s compliance with any or all Sections of the Public Contract Code identified in Section X.A. of the applicable Alpha Plan promptly after the State’s request for such certification.
We request that this notice of Certification Form be acknowledged and agreed to by signing in the spaces provided below and returning the original to Assignee and Lender.
Acknowledged and Agreed:
Lender:
______
By:
Name:
Title:
Date:
and State:
______
By:
Name:
Title:
Date:
Assignment Accepted By:
Assignee:
______
By:
Name:
Title:
Date:
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