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2021-052B
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2021-052B
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Last modified
5/6/2021 12:38:34 PM
Creation date
5/6/2021 12:26:36 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
04/06/2021
Control Number
2021-052B
Agenda Item Number
12.G.2.
Entity Name
Halley Engineering Contractors, Inc.
Subject
Award of Bid No. 2021018 for Construction of 66th Ave Roadway Widening
Area
(49th St. to 69th Street),
Project Number
IRC-1505
Bid Number
2021018
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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 <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 />i <br />(Insert name of CONTRACTOR) ; <br />Who is the CONTRACTOR for the following Project: <br />I <br />PROJECT NAME: 66TH AVENUE ROADWAY WIDENING (49TH <br />STREET TO 69TH STREET) <br />PROJECT # IRC -1505 <br />I 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 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 />I <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 />DIV 0-3—Contract Forms - 00634 - 1 <br />FAPublic Works\ENGINEERING DIVISION PROJECTS\1505-66th Ave Widen!ng_49th St to 69th St\1-Admin\Bid Documents\Master Contract Documents\DIV 0 3 Contract <br />Forms.docx <br />
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