HomeMy WebLinkAboutIowa Department of Transportation-8/15/2016Form 640003
03-04
ok Iowa Department of Transportation
\� CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY. C( aZtAtri610 COUNTY/CITY. � +1ZILLDOite
ADDRESS:idt,Lberey 5• PROJECT NO.: %S17 -:1-E -g/55 C72.3)- g V -C2
KIND OF WORK:
Artc.Oork
AGREEMENT DATE: 4// 9/00/2. FIELD COMPLETION DATE: 64q1)//!gyp
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: DATE:
Project Engineer (Res. Construction) (Area Engineer) (County) (City) (Consultant)
*SIGNATURE: DATE:
District (Construction) (Maintenance) (Local Systems) Engineer
Year
Year
Approved and work accepted by the Board of Supervisors/City Council of
this day of — -Lp-C—
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
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
❑ Copies to District
❑ Copy to Company
❑ Original to Files
Itrrr, roversheet
CITY OF WATERLOO
Council Communication
Page 1 of 1
Resolution approving Completion of Project and Recommendation of Acceptance of Work Performed for the artwork portion of the project
performed by Christophe - enn- of Keosauqua, Iowa, at a total cost of $90,000.00 in conjunction with F.Y. 2012 Lou Henry Hoover Memorial
Sculpture Garden, Co, . act No. 8
City Council Meeti . g: 8/15/2016
Prepared: 8/10/2016
REVIEWERS:
Department Reviewer Action Date
Engineering Thorson, Eric Approved 8/10/2016 - 11:00 AM
Clerk Office Felchle- Kelley Approved 8/10/2016- 3:18 PM
SUBJECT:
Submitted by:
Recommended Action:
Summary Statement:
Source of Funds:
Resolution approving Completion of Project and Recommendation of Acceptance of Work Performed
for the artwork portion of the project performed by Christopher Bennett, of Keosauqua, Iowa, at a total
cost of $90,000.00 in conjunction with F.Y. 2012 Lou Henry Hoover Memorial Sculpture Garden,
Contract No. 803.
Submitted By: Eric Thorson, PE, City Engineer
It is recommended that the artwork portion of the project be accepted and that Council approve the
"Certificate of Completion and Final Acceptance of Agreement Work" and authorize the Mayor to
sign said document.
I report that Christopher Bennett, of Keosauqua, Iowa, has completed the above referenced work in
accordance with the approved artwork agreement.
http://waterloo.novusagenda.com/AgendaWeb/CoverSheet.aspx?ItemID=5981 8/16/2016