Lee County Utilities

Developer Contributed Asset Project

Contractor’s Certification of Contributory Assets

Project Name:
Strap Number: / ,and ,and
Location:
Owner’s Name: (as shown on Deed)
Owner’s Address:
Owner’s Address: / , -
Owner’s Telephone #: / ()

Type Utility System: Potable Water &/or Fire Protection

(Please provide separate ‘Certifications’ for potable water, sanitary sewer, lift stations and reclaimed water facilities.)

Description and Cost of Material, Labor, and Services

Please list each element of the system from the drop-down list provided.

Unit cost MUST include actual cost of CONSTRUCTEDfacilities in their entirety.

ITEM
/ SIZE /
QUANTITY
/ UNIT / UNIT COST / TOTAL
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
PVC C-900 DR-14PVC C-900 DR-18PVC C-905 DR-14PVC C-905 DR-18CL-50 DIPHDPE SDR-11HDPE SDR-11 CASINGHDPE SDR-17 CASINGSTEEL CASINGFIRE LINE UP TO AND INCL 1ST OS + Y VALVEFIRE HYDRANT ASSEMBLYTAPPING SLEEVE W/VALVEGATE VALVEBLOW-OFF ASSEMBLYARVMASTER-METER ASSEMBLY(IES)SINGLE WATER SERVICE/COMPLETE DOUBLE WATER SERVICE/COMPLETE WATER MAINHYDRANT BRANCH LINEFIRE LINE (REMOVED)(RELOCATED)(GROUTED IN PLACE) / 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" x5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" 5/8"1"1.5"2"3"4"6"8"10"12"14"16"18"20"24"30"36" / LFEALS
TOTAL

(If more space is required, use additional forms(s).

I do hereby certify that the quantities of material and services described above are a true and accurate representation of the asinstalled cost of the system being contributed to Lee County and corresponds with the record drawings.

CERTIFYING:
X
(Signature of Certifying Agent)
(Name & Title of Certifying Agent)
(Name of Firm or Corporation)
(Address of Firm or Corporation)
, -

STATE OF )

) SS:

COUNTY OF )

The foregoing instrument was signed and acknowledged before me this day of , 20 by - , and who take an oath.

Notary Public Signature

Printed Name of Notary Public

Notary Commission Number (NOTARY SEAL)

Contractor’s Certification of Contributory Assets – Form (Revised - March 2012)

S:\Engineering Team\Development\Information and Forms\INFORMATION FORMS TO E-MAIL\2011 Developer Project Forms\07a - Certification of Contributory Assets (Potable Water & Fire Protection) - form.doc