HomeMy WebLinkAboutIDOT - Cont. 871 Final Acceptance of Agmnt Work - 11/5/18 pte ase return tills copy to:
Form 640003 na clerk & Flnonce berrDept.
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CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: Benton's Sand and Gravel Inc. COUNTY/CITY: Black Hawk County/Waterloo
ADDRESS : 905 Center Street, Cedar Falls , IA, 50613 PROJECT NO. : RM-8155(742)--9D-07
KIND OF WORK: Concrete Paving and Storm Sewer, FY 2015 Geraldine Road - Phase 3 City Contract No. 871
AGREEMENT DATE : February 9th, 2015 FIELD COMPLETION DATE : October 24th , 2018
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 : October, 31st 2018
Project Engine6r R . nstruction) (Area Engineer) (County) (City) Year
(Consultant)
*SIGNATURE : DATE:
District (Construction) (Maintenance) (Local Systems) Engineer Year
Approved and work accepted by the Board of Supervisors/City
Council of Waterloo
this 5th day of November 2018
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 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. ❑ Office of Audits ❑ Copy to Company
❑Copies to District ❑ Original to Files