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this Work and for every act and neglect of the OWNER and others relating to or arising out of this Work . Any <br /> payment , however , final or <br /> otherwise , shall not release the CONTRACTOR or his sureties from any obligations under the Contract Documents or the <br /> Payment and <br /> Performance Bonds . <br /> Dated 3 / 7 �7� t 'j Derrico Construction Corporation <br /> ( CONTRACTOR ) <br /> State of <br /> County of <br /> Subscribed and sworn, to before me this `% r4 <br /> day of ��� Y ° JEAN ROBERTSON <br /> Nota PUbiIC i 1 � C�C i ' !A MY COMMISSION # DD775901 <br /> Notary / "'��`'� � `-7 " " 'f'` - �OfA� EXPIRES : Sept. 26. 2009 <br /> My Commission expires : ='z i ? L `� (407) 38&0153 Ronde Nouy Service,eom <br /> CERTIFICATION OF A5 ! CT OR CONSULTING ENGINEER (WHERE APPLICABLE ) : <br /> I certify that I have checked and verify the above and foregoing Periodic Estimate for Partial Payment ; <br /> that to the best of my knowledge <br /> and belief it is a true and correct statement of the work performed and/or material supplied by the Contractor . <br /> 400�t '00 <br /> Dated <br /> ffGT / ENGINEER ) SIGNATURE <br /> CERTIFICATION OF ENGINEER / INSPAR : <br /> I have checked the estimate against the Contractor' s Schedule of Amounts for Contract Payments and <br /> the notes and reports of my <br /> inspections of the project . It is my opinion that this statement of work performed and/or materials supplied is <br /> accurate , that the Contractor is <br /> observing the requirements of the Contract , and that the Contractor should be paid the amount requested above . <br /> Dated 7 / � Ply - 2 — <br /> CT / ENGINEER) IGNATURE <br /> Accompanying Documentation : <br /> * * END OF SECTION <br /> 00622 - Contractor's Application for Final Payment - Per Marian <br /> 00622 - 2 <br /> Y .\Projects\08-383 Oslo Road IRC Labor Contract\Payment Applications\OC622 - Contractor's Application for Final Payment - Per Marian .doc Rev. 05/01 <br />