HomeMy WebLinkAboutIowa Department of Transportation-1/13/2014Form 640003
03-04 wd
1 -cm Iowa Department of Transportation
`NOCERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: Vieth Construction Corporation COUNTY/CITY: Black Hawk/ Wterloo
ADDRESS: 6419 Nordic Drive, Cedar Falls, IA 50613 PROJECT NO.: NRT-NT08(1)-9G-07
KIND OF WORK: Retaining Wall - Cast in Place
AGREEMENT DATE: November 16, 2009 FIELD COMPLETION DATE: October 17, 2012
This is to certify that the work covered by the above referenced agreement has been completed in accordance with
said agreement and is hereby accepted, subject to final audit of costs.
SIGNATURE:
*SIGNATURE:
Construction) (Area Engineer) (County) (City)
DATE: I-431/ Z®I
Year
DATE:
District (Construction) (Maintenance) (Local Systems) Engineer Year
Approved and work accepted by the Board of Supervisors/City
Council of
this I ' y day of 7(( 3
Year
SIGNATURE:
Wa+.e�--log
Chairman/Mayor
Acknowledge completion of project in accordance with referenced agreement by the Iowa Department of
Transportation
this day of
Year
SIGNATURE;
Iowa Department of Transportation
*On Local State Assisted
Projects District does
NOT certify but
acknowledges
completion of project.
DO NOT WRITE IN THIS BOX. CENTRAL OFFICE USE ONLY.
(Check or Initial Appropriate Box)
❑ Office of Audits ❑ Copy to Company
❑Copies to District ❑ Original to Files