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i <br /> 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 i <br /> BY THE CONTRACTOR AND TO ACCOMPANY CONTRACTOR'S FINAL APPLICATION FOR <br /> PAYMENT) <br /> I CERTIFY that 1 am a Florida Professional Surveyor and Mapper retained by: <br /> i <br /> i <br /> (Insert name of CONTRACTOR) <br /> Who is the CONTRACTOR for the following.Project: <br /> PROJECT NAME: 43RD AVENUE SIDEWALK <br /> IMPROVEMENTS FROM AVIATION <br /> BOULEVARD TO AIRPORT DRIVE DIVEST <br /> INDIAN RIVER COUNTY PROJECT # 1123 <br /> FURTHER CERTIFY that I have personally performed the survey work for the preparation <br /> of Record Drawings for the CONTRACTOR for this project or that such work was performed under <br /> my direct control and supervision. <br /> i <br /> 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 /> r <br /> 1 <br /> Printed Name: <br /> I <br /> Florida Professional Surveyor and Mapper Registration Number: <br /> I <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 REV 04-07 <br /> 00634-1 j <br /> F'\Public Works\ENGINEERING DIVISION PROJECTS\1123 43rd Ave Sidewalk Improvements 26th St.to Airport Dr West\Admim\bid documents\Master Contract <br /> Documents\00634-Professional Surveyor and Mappers Certification REV 04-07.doc Rev.06/01 <br />