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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 : Oslo Road ( CR 606) Phase II Roadway <br /> Widening ( 43 " Ave . to 27t Ave . ) <br /> INDIAN RIVER COUNTY PROJECT # 0533 <br /> 1 FURTHER CERTIFY that I have personally performed 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 /> FAPublic Works\ENGINEERING DIVISION PROJECTS\0533-Oslo Rd Phase II (43rd Ave to 27th Ave)\Admim\bid documents\00634 - Professional Surveyor and Mapper's <br /> Certification as to Elevations and Locations of the Work REV 04-07 .doc Rev. 06/01 <br />