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r n4 <br />1. SP C.... <br />6.... <br />M DE5 ' <br />..~... R <br />~.. i <br />• <br />~o :: <br />>~ .': <br />........ ....:::::r::: <br />I hereby certify that all items and amounts shown by this pay estimate are <br />conect for the work completed to date. <br />CONTRACTOR: JAY BROS. INC. <br />BY: <br />TITLE: <br />C _..,. <br />' p ' <br />G T. <br />RA... <br />17:£ <br />::: t :::: ::: : : :::::: <br />:.aT.l. ....:`'ii`i'E'' <br />PE IOD.. <br />N <br />5... <br />R.. <br />(1T'Y'; ''A,rytoUN3' :' ~Q7~ '~AiNOf?P17' <br />c ~,o <br />DATE: ~ ~,~ ..+ O <br />Based on the ENGINEER'S on-site inspections as an experienced and qualrfied design <br />professional and on review of application for payment and the accompanying data and <br />schedules, the ENGINEER has determined, to the best of his knowledge and belief, <br />that the quantfties shown by this estimate are correct and that, based on such inspections <br />and review, that the work has progressed to the point indicated (subject to an evaluation <br />of such work as a functioning Project upon Substantial Completion, to the results of any <br />subsequent tests required by the Contrail Documents, and to any qualrfications stated in <br />his recommendation), and that payment of the amount recommended is due Contractor(s); <br />but by recommending any payment, the ENGINEER will net thereby be deemed to have <br />reviewed the means, methods, sequences, techniques, or proceedures of construction <br />or safety precautions or programs incident thereto or that the ENGINEER has made any <br />examination to ascertain haw or for what purpose any Contractor has used the monies <br />paid on account of the Contract Price, or that title to any of the work, materials, or equipment <br />has passed to the Owner free and clear of any lein, claims, security interests or encumbrances, <br />or that the Contactors) have completed their work exactly in accordance with the Contrail <br />Documents. <br />ENGINEER HOWARD R. GREEN COMPANY <br />BY: / <br />TITLE: ' " /~OrJ~e ~, C' ~~i A.<</'~ <br />I n ~ <br />DATE: ~~f'+/' O <br />r <br />SL Pau/Regiona/WaterServfces <br />BY: <br />TITLE: ~y1(~.fLZlt.i/-tn~ ~~t"~' ~~~Q,1-~is(yvr <br />DATE: T I ~~ <br />Approved by Owner/Commission <br />C/TY OF FALCON HEIGHTS <br />BY: <br />TITLE: <br />DATE; <br />0 Wg1820386,g00111FUliel PgymetLWay Estp3 <br />FAGE4 <br />16 <br />