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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 <br />INDIAN RIVER COUNTY PROJECT # <br />INDIAN RIVER BLVD. & 17T" ST. <br />INTERSECTION IMPROVEMENTS <br />1024 <br />I FURTHER CERTIFY that I have personally performed the survey work for the preparation <br />A 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\1024-17thStreet and IR Blvd IntersectionWdmim\Contract Documents\00634 -Professional Surveyor and Mappers <br />Certification as to Elevations and Locations of the Work REV 04-07.doc Rev. 06101 <br />