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SECTION 00634 - PROFESSIONAL SURVEYOR AND MAPPER' S CERTIFICATION AS TO <br /> ELEVATIONS AND LOCATIONS OF THE WORK <br /> ( TO BE COMPLETED BY A FLORIDA PROFESSIONAL SURVEYOR AND MAPPER RETAINED <br /> BY THE CONTRACTOR AND TO ACCOMPANY CONTRACTOR ' S FINAL APPLICATION FOR <br /> PAYMENT ) <br /> I CERTIFY that I am a Florida Professional Surveyor and Mapper retained by : <br /> ( Insert name of CONTRACTOR ) <br /> Who is the CONTRACTOR for the following Project : <br /> PROJECT NAME : 6th Avenue S .W . Culvert Replacement <br /> North of 23 `d Street S .W . <br /> INDIAN RIVER COUNTY PROJECT # 1136 <br /> 1 FURTHER_ CERTIFY that_ I have r) ersonally_perormed the survey-work for the - preparation -- <br /> of Record Drawings for the CONTRACTOR for this project or that such work was performed under <br /> my direct control and supervision . <br /> I FURTHER CERTIFY that all constructed elevations and locations of the Work are in <br /> conformance with the Contract Documents , except for discrepancies listed below . <br /> [Attach additional sheets as necessary] <br /> ( SURVEYOR ' S SEAL ) <br /> CERTIFIED BY : <br /> Printed Name : <br /> Florida Professional Surveyor and Mapper Registration Number : <br /> Date Signed and Sealed by Professional Surveyor and Mapper: <br /> Company Name : <br /> Company Address : <br /> Telephone Number : <br /> 00634 - Professional Surveyor and Mapper's certification as to Elevations and Locations of the Work REV 04-07 . doc <br /> 00634 - 1 <br /> F :\Public Works\ENGINEERING DIVISION PROJECTS\ 1136-6th Ave SW_Culveri Replacement N of 23rd St SWWdminn Contract Documents\00634 - Professioial <br /> Surveyor <br /> and Mapp&s Certification as to Elevations and Locations of the Work REV 04 -07 . doc Rev . 06101 <br />