Laserfiche WebLink
STATE OF FLORIDA <br />INDIAN RIVER COUNTY <br />THIS IS Tp' RTIFY THAT THIS IS A TRUE AND CORRECT <br />COPY OFT E ORIMAL IN OFFICE. <br />JEFF] EY <br />BY A <br />// D.C. <br />DATE-�3 <br />FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />FLORIDA BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br />REQUEST FOR PAYMENT <br />PART 6 — ENGINEER'S CERTIFICATION OF PAYMENT REQUEST <br />ONLY SUBMIT IF CONSTRUCTION IS PART OF THE REIMBURSEMENT REQUEST <br />being the Professional Engineer retained by <br />(name of Professional Engineer) <br />, and responsible for overseeing construction of the Project <br />(name of Grantee) <br />described in the Agreement and do hereby certify that for DEP Agreement No. and Payment Request No. <br />1. All permits and approvals required for the construction, which is underway, have been obtained. <br />2. Payment is in accordance with construction contract provisions. <br />3. Construction up to the point of this payment request is in compliance with the approved plans and permits. <br />4. Equipment, materials, labor, and services represented by the construction invoices have been satisfactorily purchased <br />or received and applied to the project in accordance with construction contract documents filed with and previously <br />approved by the Department of Environmental Protection. <br />Professional Engineer (Physical Signature Required) <br />Firm or Affiliation <br />(Date) (P.E. Number) <br />DEP Agreement No. 23IR2, Exhibit C, Page 6 of 6 <br />