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17 7 <br /> RIM <br /> Page 4 of 5 <br /> CERTIFICATION OF ENGINEER . <br /> I certify that I have reviewed the above and foregoing Periodic Estimate for Partial <br /> Payment ; that to the best of my knowledge and belief it appears to be a reasonably <br /> accurate statement of the work performed and /or material supplied by the Contractor . I am <br /> not certifying as to whether or not the Contractor has paid all subcontractors , laborers , <br /> materialmen and suppliers because I am not in a position to accurately determine that <br /> issue . <br /> Dated <br /> SIGNATURE <br /> CERTIFICATION OF INSPECTOR . <br /> I have checked the estimate against the Contractor' s Schedule of Amounts for Contract <br /> Payments and the notes and reports of my inspections of the project . To the best of <br /> my <br /> knowledge , this statement of work performed and /or materials supplied appears to be <br /> reasonably accurate , that the Contractor appears to be observing the requirements of the <br /> Contract with respect to construction , and that the Contractor should be paid the amount <br /> requested above , unless otherwise noted by me . I am not certifying as to whether or <br /> not <br /> the Contractor has paid all subcontractors , laborers , materialmen and suppliers because I <br /> am not in a position to accurately determine that issue . <br /> Dated <br /> SIGNATURE <br /> [The Remainder of This Page Was Left Blank Intentionally] <br /> 00622 - Contractor's Application for Payment - 03- 10 rev . doc <br /> 00622 - 4 <br /> F :\Public Works\ENGINEERING DIVISION PROJECTS\0845- Dixie Hwy Sidewalk US1 _691h ( LAP )Wdmim\bid documents\00622 - Contractor's Application for Payment <br /> - 03- 10 rev .doc <br /> Rev . 05/01 <br /> :z, <br />