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2003-057
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2003-057
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Last modified
2/2/2017 10:25:13 AM
Creation date
9/30/2015 6:23:10 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Miscellaneous
Approved Date
03/04/2003
Control Number
2003-057
Agenda Item Number
11.H.3
Entity Name
Department of Evironmental Protection
Subject
North County Reverse Osmosis Brine Relocation Project
Archived Roll/Disk#
3160
Supplemental fields
SmeadsoftID
3179
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Engineer's Certification <br /> of Disbursement Request <br /> I, M I C H A EL C . " TCO TCO k ! 5 5 , being the Professional Engineer retained by <br /> (name of Professional Engineer) <br /> lAtil 11 veA r ft tJrl 0TH / VCS , am responsible for overseeing construction of the <br /> (name of Grantee/Recipient) <br /> project described in the Agreement and do hereby certify that: <br /> 1 . 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 /> 2. Payment is in accordance with construction contract provisions ; <br /> 3 . Adequate construction supervision is being provided to assure compliance with construction requirements and <br /> Florida Administrative Code Rule 62-600 or Rule 62-604, as appropriate; <br /> 4 . Construction up to the point of this disbursement is in compliance with the contract documents ; <br /> 5 . All changes, additions, or deletions to the construction contract(s) have been documented by change order and all <br /> change orders have been submitted to the Department; and <br /> 6 . All additions or deletions to the Project which have altered the Project' s performance standards, scope, or purpose <br /> (since issue of the pertinent Department permit) have been identified in writing to the Department or are identified <br /> and attached hereto . (An attachment is included) . <br /> Yes No ❑ <br /> Signature of Professional Engineer <br /> co �,�� r1 UTiC / r/,�5' <br /> Firm or Affiliation <br /> 3 - 62 - a 3 3gs/ L <br /> (Dau) (P.E. Number) <br /> Indian River Co . Approved Date <br /> Administration <br /> Utilities 1 1/ <br /> Budget l /3 <br /> Risk Manager <br /> DEP Agreement No . LP###, Attachment B , Page 3 of 3 <br />
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