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1 EXHIBIT H <br /> <br />3 <br /> <br />FORM OF WRITTEN REQUISITION <br /> <br />5 [INSERT NAME AND ADDRESS OF TRUSTEE] <br /> <br /> 7 RE: <br /> 9 <br /> <br />11 <br /> <br />13 <br /> <br />Disbursement from the Claims Payment Fund pursuant to <br />Section 3.02 of the Trust Indenture, dated as of <br /> 1, 1988 (the "Indenture"), by and between <br /> , as Trustee (the "Trustee") and Big <br />Independent cities Excess Pool Joint Powers Authority, <br />joint exercise of powers authority organized under <br />California law (the "Authority'~) <br /> <br />15 <br /> <br />17 <br /> <br />19 <br /> <br />21 <br /> <br />23 <br /> <br />25 <br /> <br />27 <br /> <br />29 <br /> <br />31 <br /> <br />33 <br /> <br />35 <br /> <br />37 <br /> <br />39 <br /> <br />41 <br /> <br />43 <br /> <br />45 <br /> <br />47 <br /> <br />49 <br /> <br />REQUISITION NO. <br /> <br /> You are hereby~ instructed to pay to th~ undersigned <br />Participant, or to at <br />$ as a Settlement from the Claims Payment Fund <br />as provided in Section 3.4 of the Liability Risk Coverage <br />Agreement dated as of 1, 1988, among the <br />Participants named therein and the Authority (the "Coverage <br />Agreement"). This amount has been ~..cu_~es' within the scope of <br />Coverage (as defined in the Coverage Agreement), has been <br />settled or finally adjudicated in accordance with the terms of <br />the Coverage Agreement and the Memorand'~m of Coverage appended <br />thereto and has not been the basis of any previous <br />disbursements. <br /> <br /> Attached hereto is a certified copy of the <br />[settlement/judgment] and itemized list of costs and expenses <br />in connection with the Settlement. <br /> <br /> [In the case of disbursement to pay a Pure Premium <br />Adjustment refund, the following form shall be used: You are <br />hereby instructed to pay to the Authority the amount of <br />$ to be paid to one or more of the Participants as <br />a Pure Premium Adjustment refund. Such amount has been <br />computed in accordance with Section 4.5 of the Liability Risk <br />Coverage Agreement dated as of 1~ 1988 among the <br />Participants named therein and the Authority and is properly <br />payable at this time.] <br /> <br /> lin the case of withdrawal or expulsion of a Participant, <br />the following form shall be used: You are hereby instructed to <br />pay to the undersigned Authority the Allocable Share of <br /> as Participant, as determined in accordance With <br />Section 5.2 of the Liability Risk Coverage Agreement dated as <br />of 1, 1988 among the Participants named therein <br />and the Authority, for safekeeping in a segregated account by <br /> <br />H-1 <br /> <br /> <br />