HomeMy WebLinkAboutK&W Electric - Completion of Project and Acceptance of Work - 2/4/2020Form 640003
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QIowADOT
CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: KW ELECTRIC C UNTY/CITY: WATERLOO
ADDRESS: 1127 LINCOLN ST, CEDAR FALL, IA 50603 PROJECT NO.:
KIND OF WORK: TRAFFIC SIGNALS
CS-TS F-8155 (749)--85-07
AGREEMENT DATE: 6/8/2016 FIELD COMPLETION DATE: 01/08/2020
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)
DATE: January 29 2020
DATE:
District (Construction) (Maintenance) (Local Systems) Engineer Year
Year
Approved and work accepted by the /City
Council of
this
day of K 7..ef7-6
Year
SIGNATURE: l
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
01/31/18 Appendix 12-1