OOC003 03/28/17	MARYLAND STATE HIGHWAY ADMINISTRATION

DISTRICT ENGINEER'S CERTIFICATE OF COMPLETION OF WORK

DATE:

To:	Director, Office of Construction

Re: Completion of Contract No.	FAP No:

Route No / Name:

Location / Limits of Work:

Description/Type of Work:

Contractor:

An inspection of this project was made on	by the following attendees:

Name	Title	Representing

Except for the comments noted below, the work was found to be satisfactorily completed in conformance with the Contract Documents.

Exceptions:

Therefore, in compliance with the requirements of Section GP-5.13 and TC-7.06 of the Standard Specifications, I recommend the acceptance of the work performed under this contract and release the Contractor from any further work, including maintenance, within the limits of this project.

Signed:	,

(District Engineer)	(Date)

Date:	Days

Advertised:	Working Calendar Days Charged	=

Bids Received:	No Charge Days:

Notice of Award:	Sundays	=

Execution of Contract:	Holidays	=

Notice to Proceed Letter:	Bad Weather	=

On or Before:	Other	=

*Time Charges Began:

Work Started:	Total No Charge Days:	=

Surfacing Completed:

Opened to Traffic:	Complete Work Suspension

Accepted for Maintenance:	From	to	=

*Contract :	From	to	=

Project Accepted:

Partial Work Suspension

Days	From	to	=

From	to	=

Allowed:	Total Closed Down	=

Charged:	Grand Total Elapsed Days	=

Under:	*Difference in Calendar Dates	=

Over:

Extended:	Total Number of Additional Work Requests:

Assessed:

Total Number of Change Orders:

Total Amount of Change Orders:	$

Liquidated Damages should be assessed on the following basis:

Work Days Calendar Days @ $	per day = $

A clearance for materials approval dated	has been received.

This contract included:	No pavement	Only Rigid pavement

Only Flexible pavement	Flexible and Rigid pavement

• Rigid pavement has been core drilled to check its thickness.	Yes	No	N/A

• A certification of drilling results has been received.	Yes/Date	No	N/A

• The rigid pavement meets the thickness requirements of the specifications.	Yes	No	N/A

• Pavement deficient in thickness by more than 1" has been replaced.	Yes	No	N/A

• The penalty for rigid pavement of deficient thickness left in place has been computed to be $	, which amount should be deducted from any amounts due the contractor.

The Initial Bridge Condition Inspection Report from the OOS has been received. Yes No Not Required

The ADA Compliance Report has been received. Yes No Not Required

The Final Inspection Report from OOTS has been received. Yes No Not Required

All weekly payroll statements of compliance as required by the Copeland "Anti-Kickback" Act for Federal Aid projects
have been received. Yes No

Certified copies of all payrolls and the final wage rate and labor classification certification, as required for Federal Aid projects, have been received. Yes No

The MDSPGP Permit Compliance-Self Certification Form has been completed and forwarded to the Office of Environmental Design, Environmental Programs Division. Yes No Not Required

The Stormwater Management As-Built Certification has been submitted to and approved by the Office of Highway Development, Highway Hydraulics Division. Yes No Not Required

The National Pollutant Discharge Elimination System (NPDES) requirements have been met and the Notice of Termination (NOT) has been submitted to OHD Highway Hydraulics Division and confirmed with them that it was submitted to MDE.

Yes No Not Required

Remarks: