Ministry of CERTIFICATION OF THE INSTALLATION

Transportation OF PIPE CULVERTS

CONTRACT: __________________________________________________________________

LOCATION: __________________________________________________________________

Certification Stage (check one): Contract Tender Items Completion [ ]

Construction Season Tender Items Completion [ ]

Representative’s Signature: _______________________________________________________

Certification Date: ____ / ____ / ______

MM DD YYYY

In compliance with SP 104S02, the authorized representative of the Contractor confirms that all
Quality Control processes have been carried out and certifies that the following Pipe Culverts
have been supplied, installed and completed in general conformance with the Contract
Documents and are ready for post installation inspection.

Highway Section: From Station ___________ To Station ___________

Location Of Culvert Installed Culvert Pipe Culvert Length Date

(Station) Pipe Code (m) Culvert Installed

PH-CC-822PIC Oct-12