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Contractor (Name and Address):
Description and Location of Work:
Contract No.:
Project No.:
Effective Date (YYYY-MM-DD):
The undersigned certify that the work has been inspected and is complete except the portion of work described on the attached list.
Position or Title Architectural:
Representing Architectural:
Signature Architectural: ___________________________________________
Date (YYYY-MM-DD) Architectural:
Position or Title Civil:
Representing Civil:
Signature Civil: ___________________________________________
Date (YYYY-MM-DD) Civil:
Position or Title Electrical:
Representing Electrical:
Signature Electrical: ___________________________________________
Date (YYYY-MM-DD) Electrical:
Position or Title Mechanical:
Representing Mechanical:
Signature Mechanical: ___________________________________________
Date (YYYY-MM-DD) Mechanical:
Position or Title Contractor:
Representing Contractor:
Signature Contractor: ___________________________________________
Date (YYYY-MM-DD) Contractor:
I certify that the work is substantially complete except for the portions described on the attached list. Certified pursuant to Section 34 of the Financial Administration Act.
Departmental Representative:
Date (YYYY-MM-DD):
Clear Data
