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ANN <br /> SECTION 00634 - PROFESSIONAL SURVEYOR AND MAPPER' S CERTIFICATION AS TO <br /> ELEVATIONS AND LOCATIONS OF THE WORK <br /> w <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 /> w <br /> (Insert name of CONTRACTOR) <br /> Who is the CONTRACTOR for the following Project: <br /> w <br /> PROJECT NAME : 4h Street / Cooch Ditch Bridge Replacement <br /> 11 `" Street SW Paving & Drainage <br /> INDIAN RIVER COUNTY PROJECT # 0209 & 9321 <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 />■ <br /> (SURVEYOR'S SEAL) <br /> P CERTIFIED BY: <br /> Printed Name : <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 /> I <br /> 0209-00634 - Professional Surveyor and Mapper's Certification as to Elevations and Locations of the Work.doc <br /> 00634 - 1 <br /> F.1EngineannglCaNal PrgectsW2094th Street Bndge Over Conch Ditch O209-4th St eet fridge Over Cooch W-20-06=09-00634 - Professional Surveyor and MappWs <br /> Certification as to Elevabons and Locabons of the Work.docRev. 06!01 <br />