HomeMy WebLinkAboutIOWA DOT Form 640003
03-04 wd
er; Iowa Department of Transportation
CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: B&B Buiders COUNTY/CITY: Waterloo
ADDRESS: 5827 Sierra Drive, Waterloo, Iowa 50701 PROJECT NO.: CS-TSF-8155(681)--85-07
F0,41,-"6 4 Sara ,,.
KIND OF WORK: Construction (Part of this project was done in-house.)
AGREEMENT DATE: 7-7-2005 FIELD COMPLETION DATE: 09-01-2006
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: 6DATE: 12-08 , 2006
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 Board of Supervisors/City
Council of
this day of _
Year
SIGNATURE:
Chairman/Mayor
Acknowledge completion of project in accordance with referenced agreement by the Iowa Department of
Transportation
this _5 day of /9C—CC- 16/2 , 2 2 .
Year
SIGNATUR :
a Dep ment 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 n
completion of project. I I Office of Audits IOt�IADEPARYMEMOEIRP�SPORiONCopy to Company
Dist ict 2
nCopies to District DEC a 2006— Original to Files
MASON CITY,IA