Professional Seals Page
|Project No: | |Date Submitted: | |
|Project Title: | |Original Post Bid Submittal: | Yes No |
|Facility Name: | | | |
|Contractor: | |Accompanying Requisition for Payment No.: | |
(FORM TO BE USE BY THE SELECTED BIDDER ONCE THEY HAVE BEEN ASSIGNED A PROJECT UNDER CSMP)
|A |B |C |D |E |
|According to the best of my knowledge and belief, I certify that all items and | | | | |
|amounts shown on this certificate are correct, that all work has been performed and | | | | |
|material supplied in full accordance with the terms and conditions of the Contract. | | | | |
|I further certify that all just and lawful bills against the undersigned and his | | | | |
|subcontractors for labor, materials, and equipment employed in the performance of the| | | | |
|Work have been paid in full in accordance with the Contract’s terms and conditions. | | | | |
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|Submitted By: | | | | |
|Company Name & Address: | | | |Signature |
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|Phone: | | | |Title |
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