HomeMy WebLinkAboutK&W Electric Project Completion and Acceptance of Work - 3/2/2020Form 640003
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CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: KW Electric
Please return this copy to:
City Clerk & Finance Dept.
715 Mulberry St.
Waterloo, IA 50703
COUNTY/CITY: Black Hawk! waterloo
ADDRESS: 1127 Lincoln St, Cedar Falls, IA 50613 PROJECT NO.: CS-TSF-8155(749)--85-07
KIND OF WORK: Traffic Signals
AGREEMENT DATE: 08/12/2015 FIELD COMPLETION DATE: 02/14/2020
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:
DATE: February 24 2020
Project Engineer (Res. Construction) (Area Engineer) (County) (City) Year
(Consultant)
*SIGNATURE: DATE:
District (Construction) (Maintenance) (Local Systems) Engineer Year
Approved and work accepted by the /City
Council of
this 2. day of 'rc-41
Year
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SIGNATURE: k]zt-
-61-.... n/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