HomeMy WebLinkAboutIOWA DOT CERT OF COMPLETION RESOLUTION 2009-51 Form 640003 p-&? ® - J/
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Iowa Department of Transportation
CERTIFICATE of COMPLETION and
FINAL ACCEPTANCE of AGREEMENT WORK
COMPANY: Peterson Contractors, Inc. COUNTY/CITY: City of Waterloo/Black Hawk County
ADDRESS: P.O. Box A, Reinbeck, Iowa 50669 PROJECT NO.: RM-8155(695)--9D-07
KIND OF WORK: Grade and Pave
AGREEMENT DATE: 11/2/06 FIELD COMPLETION DATE: 4/29/08
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, bject to final audit of costs.
SIGNATURE: Z, ,. DATE: 114,), , 2ao9
Project-. gineer(Res.Co uction)(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
-I\
this �G day of --Sc¢.mu.a-(y , a00 9 .
Year
SIGNATURE:
Chi an/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. n Office of Audits ❑ Copy to Company
❑Copies to District ❑ Original to Files
L:\work\project\957971admn\CRS\DOT-Form 640003-Cert.of Completion.doc