HomeMy WebLinkAboutLodge Construction, Inc. - Certificate of Completion - Project No. CS-TSF-8155(777)--85-07 - 11.6.2023Form 640003
03-04 wd
��IOWADOT
CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: Lodge Construction Inc
ADDRESS: 119 E Superior St, Clarksville, IA 50619
KIND OF WORK: CONSTRUCTION (ROUNDABOUT)
COUNTY/CITY: Waterloo
PROJECT NO.: CS-TSF-8155(77) - - 85-07
AGREEMENT DATE:
August 30, 2021
FIELD COMPLETION DATE:
August 07, 2023
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.
grant3 6=tr; o , >. w , oE, a-,ou. .
SIGNATURE: Mohammad ElahiL �° ---
*SIGNATURE:
�RPo �E
Project Engineer (Res. Construction) (Area Engineer) (County) (City)
(Consultant)
District (Construction) (Maintenance) (Local Systems) Engineer
DATE: Oct 10
DATE:
2023
Year
Year
Approved and work accepted by the /City
Council of
this 6th
day of
November 2023
Year
Waterloo, Iowa
SIGNATURE: aterdin f1
Chairman/n,:dyor
Acknowledge completion of project in accordance with referenced agreement by the Iowa Department of
Transportation
this 4th day of January
2024
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