HomeMy WebLinkAboutIowa Department of Transportation-5/7/2012Form 640003
03-04 wd
Iowa Department of Transportation
`~ CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
Please return this copy to:
City Clerk & Finance Department
715 Mulberry Street
Waterloo, IA 50703
COMPANY: Stickfort Construction Corporation COUNTY/CITY: City of Waterloo/Black Hawk Co.
ADDRESS: P.O. Box 447, Hudson, Iowa 50643 PROJECT NO.: RM -8155(722)-9D-07
KIND OF WORK: PCC Pavement - Grade and New
FY 2011 Midport Boulevard Extension - Phase II
AGREEMENT DATE:
5/16/2011 FIELD COMPLETION DATE: 2/17/12
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:
Project Engineer (Res. Construction) (Area Engineer) (County) (City)
(Consultant)
District (Construction) (Maintenance) (Local Systems) Engineer
DATE: May 1 , 2012
DATE:
Year
Year
Approved and work accepted by the Board of Supervisors/City Council of
this
day of
•Year
SIGNATURE:
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)
0 Office of Audits 0 Copy to Company
❑Copies to District ❑ Original to Files
60189781/307/Certificate of Completioadoc