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2007-392
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2007-392
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Last modified
6/28/2016 11:38:18 AM
Creation date
9/30/2015 11:27:43 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Application
Approved Date
11/20/2007
Control Number
2007-392
Agenda Item Number
7.F.
Entity Name
Underground Utilities,Inc.
Subject
Application for Final Payment No.3
Change Order No.01 Phase III Release of retainage
Area
CR 510, CR 512
Project Number
9611, 001
Supplemental fields
SmeadsoftID
6688
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other than claims in stated amounts as may be specifically excepted by the CONTRACTOR for all things done or furnished in connection with <br /> this Work and for every act and neglect of the OWNER and others relating to cr arising out of this Work. Any payment , however, final or <br /> otherwise , shall not release the CONTRACTOR or his sureties from anv obligations under the Contract Documents or the Payment and <br /> Performance Bonds . / <br /> Dated <br /> /(PONTf�OR) <br /> By: &LA_ e <br /> State of FIIMd a- <br /> County of T,-, NG <br /> Subscribeo and sw rn to before me this <br /> day Of o� D p M" CONSTANCE W. YOUNG <br /> 1 rA• <br /> is _ MY COMMISSION DD 608243 <br /> n c ✓ 1 �S b— *� tr• gs EXPIRES: October 23, 2010 <br /> Notary Public <br /> BondedIDvNolary Publk Untleiwrners <br /> My Commission expires : D Q--3r a-�5 c�- bl D <br /> CERTIFICATION OF ARCHITECT OR CONSULTING ENGINEER (WHERE APPLICABLE) ' <br /> I certify that I have checked and verify the above and foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge <br /> and belief it is a true and correct statement of the work perfo med and/or material upplied by the Contractor. <br /> Dated � �l O ' 4 a� <br /> (ARetitTECT / ENGINEEK SIGNATURE <br /> CERTIFICATION OF ENGINEER / INSPECTOR: <br /> I have checked the estimate against the Contractor's Schedule of Amounts for Contract Payments and the notes and reports of <br /> my <br /> inspections of the project. It is my opinion that this statement of work performed and/or materials supplied is accurate , that the Contractor <br /> is <br /> observing the requirements of the Contract, and that the Contractor should be paid the amount requested above . <br /> Dated <br /> / (ARC TECT / ENGINEER IGNATURE <br /> Accompanying Documentation : <br /> 0CR 512 - Contractor's Application for Final Payment - Per Marian <br /> C9Dowments and Settings\George FrenchlDesktoplCR 5121CR 512 - Coniractole Applicelion for Final Payment - Per Marian doc - 2.doc Rev. 05/01 <br />
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