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r <br /> SECTION 00634 = PROFESSIONAL SURVEYOR AND MAPPER' S CERTIFICATION AS TO <br /> ELEVATIONS AND LOCATIONS OF THE WORK <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 /> CERTIFY that I am a Florida Professional Surveyor and Mapper retained by : <br /> i <br /> ( Insert name of CONTRACTOR ) <br /> Who is the CONTRACTOR for the following Project : <br /> PROJECT NAME : 41St Street Roadway Improvements <br /> INDIAN RIVER COUNTY PROJECT # 0016 & 0236 <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 /> 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 /> ( SURVEYOR ' S SEAL ) <br /> CERTIFIED BY : <br /> Printed Name : <br />■ <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 /> 0016-00634 - Professional Surveyor and Mapper's Certification as to Elevations and Locations of the Work <br /> 00634 - 1 <br /> FAEngineering\Capital Projects\0016 & 0236- 41st Street Improvements\0016 & 0236-41st St Contract Docs\0016-00634 - Professional Surveyor and Mappers Certification <br /> as <br /> to Elevations and Locations of the Work.doc Rev. 06101 <br />