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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 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 /> **************************************************************************************************** <br /> [The Remainder of This Page Was Left Blank Intentionally] <br /> 00622 - Contractor's Application for Payment - 03- 10 rev. doc <br /> Application for Payment - 03- 10 rev. doc Rev. OS/O1 ppubltWorks\ENGINEERING DIVISION PROJECTS\0923A Trans Florida Greenway 006 Sebastian River Middle <br /> School )\Admim\Contract Documents\00622 - Contractor's <br /> A <br />