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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 <br /> am not certifying as to whether or not the Contractor has paid all subcontractors, <br /> laborers, materialmen and suppliers because I am not in a position to accurately <br /> determine that issue. <br /> Dated <br /> SIGNATURE <br /> CERTIFICATION OF INSPECTOR: <br /> I have checked the estimate against the Contractor's Schedule of Amounts for <br /> Contract Payments and the notes and reports of my inspections of the project. To the <br /> best of my knowledge, this statement of work performed and/or materials supplied <br /> appears to be reasonably accurate, that the Contractor appears to be observing the <br /> requirements of the Contract with respect to construction, and that the Contractor <br /> should be paid the amount requested above, unless otherwise noted by me. I am not <br /> 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 /> [The Remainder of This Page Was Left Blank Intentionally] <br /> 165 <br />