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2003-254
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2003-254
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Entry Properties
Last modified
11/22/2016 1:56:05 PM
Creation date
9/30/2015 6:56:23 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Change Order
Approved Date
09/23/2003
Control Number
2003-254
Agenda Item Number
7.F.
Entity Name
Tri-Sure Corporation
Subject
16" sewage Force Main on Old Dixie Highway
Area
Old Dixie Highway
Project Number
UCP 2216
Archived Roll/Disk#
3207
Supplemental fields
SmeadsoftID
3430
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- Votary Public <br /> W Commission expires : <br /> CERTIFICATION OF ARCHITECT OR 04 ULTING ENGINEER WHERE <br /> 1 certify that I have checked and verify the a ove and foregoing Periodic Estimate or ��� L <br /> Payment; that to the best of my knowledge and belief it is a true and correct statement of the work <br /> Ner7c�trrf' d and/or material supplied by the Contractor. <br /> Dated <br /> AR HITS NGINEER) SIGNATU <br /> RE <br /> CERTIFICATION OF ENGINEER / N <br /> t have checked the estimate against the R • Contractors Schedule <br /> Payments and the notes and fepor#S of m of Amounts for Contract <br /> statement of work performed and/or Materials tsupplietd is accurate , <br /> the hat the Contractct, it is My or ion that this <br /> the requirements 'of the Contract , and that the Contractor should be paid the amount re serving <br /> above . <br /> quested <br /> Dated <br /> Accompanying Documentation : Itemized List of br / ENGINE R) SIGNATURE <br /> a <br /> "rid items <br /> " * END OF SECTION <br /> 90 T I trsLZLL <br /> .aa Ion * -� a i I a � sew dl; z T 60 ao unr <br />
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