State Form 1084 "Certificate of Substantial Completion" - Indiana

What Is State Form 1084?

This is a legal form that was released by the Indiana Department of Administration - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2010;
  • The latest edition provided by the Indiana Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of State Form 1084 by clicking the link below or browse more documents and templates provided by the Indiana Department of Administration.

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Download State Form 1084 "Certificate of Substantial Completion" - Indiana

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CERTIFICATE OF SUBSTANTIAL COMPLETION
State Form 1084 (R / 9-10) / DAPW 5
INDIANA PUBLIC WORKS PROJECT NUMBER:
PROJECT NAME:
TO:
Department of Administration
State of Indiana
THROUGH:
L. Thomas Coulter, Director Public Works
DESIGNER:
CONTRACTOR:
CONTRACT FOR:
(
GENERAL, MECHANICAL, ELECTRICAL, OTHER)
CONTRACT DATE:
CONTRACTOR P.O.NO:
PROJECT OR DESIGNATED AREA SHALL INCLUDE:
The contractor hereby certifies the Work of this project to be in complete conformance to the Contract Documents and
to be substantially complete, enabling the Owner to make use of the Work as intended.
By his signature below the Contractor further requests Designer and Owner to inspect the Work and to concur in the
Work’s substantial completion by their signature and/or to provide in a timely manner to Contractor a listing of work
items adjudged by them as remaining to be completed or corrected. Contractor agrees to complete and correct all work
items representative of such listing within
days from date of receipt from designer.
_________________________________
______________
Contractor Company Name
By (written) (typed or printed)
Date
(Shall be signed by same representative who signed Contract)
A list of items to be completed or corrected, verified by the Designer and Owner, is (is not) appended hereto. Failure to
include any incomplete items on such list does not alter the responsibility of the Contractor to provide all Work in
complete conformance with the Contract Documents.
______________________________________
______________
Designer Company Name
By (written) (typed or printed)
Date
(Shall be signed by Designer of Record with Certification Responsibility to the State of Indiana)
The Work performed under this Contract has been reviewed and found to be substantially complete by the Director of
Public Works who has hereby established the Date of Substantial Completion as _______ which is also the date of
commencement of all warranties and guarantees required by the Contract Documents. The Date of Substantial
Completion of the Work or designated portion thereof is the date established by the Director of Public Works when
construction is sufficiently complete, in accordance with the Contract Documents, so the Owner may occupy the Work,
or designated portion thereof, for the use for which it is intended.
The Owner accepts the Work or designated portion thereof as substantially complete and assumes full possession
thereof, in accordance with the contract documents.
STATE OF INDIANA
_____________________________________
______________
Owner
By: L. Thomas Coulter Public Works Director
Date
(Shall be signed by Director of Public Works as Owner’s representative)
The responsibilities of the Owner and the Contractor for maintenance, heat, utilities and insurance shall be as set out in
the Contract Documents.
CERTIFICATE OF SUBSTANTIAL COMPLETION
State Form 1084 (R / 9-10) / DAPW 5
INDIANA PUBLIC WORKS PROJECT NUMBER:
PROJECT NAME:
TO:
Department of Administration
State of Indiana
THROUGH:
L. Thomas Coulter, Director Public Works
DESIGNER:
CONTRACTOR:
CONTRACT FOR:
(
GENERAL, MECHANICAL, ELECTRICAL, OTHER)
CONTRACT DATE:
CONTRACTOR P.O.NO:
PROJECT OR DESIGNATED AREA SHALL INCLUDE:
The contractor hereby certifies the Work of this project to be in complete conformance to the Contract Documents and
to be substantially complete, enabling the Owner to make use of the Work as intended.
By his signature below the Contractor further requests Designer and Owner to inspect the Work and to concur in the
Work’s substantial completion by their signature and/or to provide in a timely manner to Contractor a listing of work
items adjudged by them as remaining to be completed or corrected. Contractor agrees to complete and correct all work
items representative of such listing within
days from date of receipt from designer.
_________________________________
______________
Contractor Company Name
By (written) (typed or printed)
Date
(Shall be signed by same representative who signed Contract)
A list of items to be completed or corrected, verified by the Designer and Owner, is (is not) appended hereto. Failure to
include any incomplete items on such list does not alter the responsibility of the Contractor to provide all Work in
complete conformance with the Contract Documents.
______________________________________
______________
Designer Company Name
By (written) (typed or printed)
Date
(Shall be signed by Designer of Record with Certification Responsibility to the State of Indiana)
The Work performed under this Contract has been reviewed and found to be substantially complete by the Director of
Public Works who has hereby established the Date of Substantial Completion as _______ which is also the date of
commencement of all warranties and guarantees required by the Contract Documents. The Date of Substantial
Completion of the Work or designated portion thereof is the date established by the Director of Public Works when
construction is sufficiently complete, in accordance with the Contract Documents, so the Owner may occupy the Work,
or designated portion thereof, for the use for which it is intended.
The Owner accepts the Work or designated portion thereof as substantially complete and assumes full possession
thereof, in accordance with the contract documents.
STATE OF INDIANA
_____________________________________
______________
Owner
By: L. Thomas Coulter Public Works Director
Date
(Shall be signed by Director of Public Works as Owner’s representative)
The responsibilities of the Owner and the Contractor for maintenance, heat, utilities and insurance shall be as set out in
the Contract Documents.