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w <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 /> 1` PAYMENT) <br /> I CERTIFY that I am a Florida Professional Surveyor and Mapper retained by: <br /> r <br /> r' (Insert name of CONTRACTOR) <br /> Who is the CONTRACTOR for the following Project: <br /> PROJECT NAME : CR 512, PHASE IV ROADWAY IMPROVEMENTS <br /> INDIAN RIVER COUNTY PROJECT # 9611 <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 /> r <br /> Ir <br /> [Attach additional sheets as necessary] <br /> (SURVEYOR' S SEAL) <br /> CERTIFIED BY: <br /> r <br /> Printed Name : <br /> r' Florida Professional Surveyor and Mapper Registration Number: <br /> Date Signed and Sealed by Professional Surveyor and Mapper: <br /> r <br /> Company Name : <br /> Company Address: <br /> ., Telephone Number: <br /> 00634 - Professional Surveyor and Mapper's Certification as to Elevations and Locations of the Work REV 04-07.doc <br /> 00634 - 1 <br /> F aEngirwetiiglCaplal Projecfs15611-CR 512 Widenin;W11 CR 512 PHASE MConnad Documents100634 - Professional Smveyor and Mappefs Certification as to Elevations <br /> and Laratbns of the Won[ REV 04-07.doc <br />