CONSTRUCTION COMPLETION

April 2004

Page 1 of 1
CERTIFICATE FOR COMPLETION
OF CONSTRUCTION

Kansas Dept. of Health & Environment

Bureau of Water
1000 SW Jackson Street, Suite 420
Topeka, Kansas 66612-1367

In accordance with Section 2.04(b) of the Loan Agreement dated Effective as of ,

by and between the , as Municipality and the State of Kansas (KDHE),
and identified as Project Number ___________,the undersigned, acting as authorized
representative of the Municipality, hereby certifies that as of , the
construction of the project has been completed in accordance with the plans and specifications
therefore, and all costs and expenses incurred in the construction of the Project have been paid
except costs and expenses the payment of which is not yet due or is being retained or contested
in good faith by the Municipality.

Notwithstanding the foregoing, this certification is given without prejudice to any rights against
third parties which exist at the date of this certificate or which may subsequently come into
being.

Executed at , Kansas this day of , .

_______________________________________
Authorized Representative (type or print)

_______________________________________
Authorized Representative (signature)
(Seal)

ATTEST:

By: __________________________________________

Title: __________________________________________