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IN <br /> • <br /> INN INN I <br /> IN <br /> IN <br /> Ilk I <br /> If INN , IN <br /> INN N <br /> IN <br /> Dated <br /> .I 41 4 <br /> ( CONTRACTOR ) <br /> 116 6 , By : ANN <br /> k ;. . <br /> State ofINN : <br /> County of INNN% INN <br /> Subscribed and sworn to before me this <br /> day of <br /> NN <br /> INN Notary Public <br /> My Commission expires : <br /> CERTIFICATION OF ARCHITECT OR CONSULTING ENGINEER WHERE APPLICABLE <br /> INN <br /> I certify that I have checked and verify the above and foregoing Periodic Estimate for <br /> Partial Pa menu that <br /> knowledge and belief it is a true and correct statement of the work performed and/or material su lied y to <br /> the best of my <br /> pp by the Contractor. t <br /> INN <br /> Dated Ilk IN <br /> Ilk <br /> INN 0 (ARCHITECT / ENGINEER ) SIGNATURE <br /> IN CERTIFICATION OF ENGINEER / INSPECTOR : I IN IN <br /> IN,INN <br /> I have checked the estimate against the Contractor' s Schedule of Amounts for Contract Payments and the notes <br /> inspections of the project , It is my opinion that this statement of work performed and/or materials supplied is accuratand <br /> reports that the Contraa my <br /> INN is observing the requirements of the Contract , and that the Contractor should be paid the amount requested <br /> abov ' ctor <br /> e . INN <br /> Dated <br /> INN <br /> (ARCHITECT / ENGINEER ) SIGNATURE <br /> Accompanying Documentation : <br /> I I NN IN <br /> INN,I <br /> IN <br /> If <br /> 00800 - 30 <br />