HomeMy WebLinkAboutIowa Department of Transportation-6/14/2010Form 640003
03-04 wd
f:83% Iowa Department of Transportation
CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: Stickfort Construction Company COUNTY/CITY: Black HawklWaterloo
ADDRESS: 3759 Ranchero Road, Cedar Falls,IA 50613 PROJECT NO.: RT-RVVVV(002)--9H-07
KIND OF WORK: PCC Recreational Trail
AGREEMENT DATE: March 16, 2009 FIELD COMPLETION DATE: November 25, 2009
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:
„ . : _ R"- onstruction) (Area Engineer) (County) (City)
Itant)
District (Construction) (Maintenance) (Local Systems) Engineer
DATE: z/15
DATE:
Year
Year
Approved and work accepted by the Board of Supervisors/City
Council of
this 7 Lliday of 'd L
Year
SIGNATURE:
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 DO NOT WRITE IN THIS BOX. CENTRAL OFFICE USE ONLY.
Projects District does (Check or Initial Appropriate Box)
NOT certify but
acknowledges
completion of project. 0 Office of Audits 0 Copy to Company
['Copies to District 0 Original to Files