PETITION TO THE CITY OF CAMERON, MISSOURI TO ACCEPT PUBLIC INFRASTRUCTURE IMPROVEMENTS AND CERTIFICATE OF COMPLIANCE

The undersigned are owners of all fee interests in and developers of property described hereon and hereby petition the City of Cameron, Missouri to accept improvements within said property as public infrastructure in perpetuity as public domain; the location of public improvements are evidenced on the subdivision plat.

Name of Subdivision______________________________________________

Legal description_________________________________________________
______________________________________________________________

The undersigned hereby certifies to the City of Cameron that:

1.  The construction of the subdivision has been inspected by the City of Cameron
      staff and found to be completed and in compliance.
2.  All work in connection with said subdivision has been performed in a workmanlike
     manner and in accordance with the plans, permits, and specifications authorized 
     and approved in compliance with the proposal.
3.  As-built drawings showing all deviations from original plans and locations of valves
     and fittings have been submitted to the City or are included herewith.
4.  Certification has been provided that the work complies wit the City's Storm
     Water Ordinance.
5.  Maintenance guarantee has been submitted and accepted by the City.
6.  The date of the completion of the project is the date of this Certificate.
7.  Title to the property covered by any easements to be accepted by the City
     has been released from the lien of any deeds of trust and is not subject to any
     liens, including without limitation mechanics' liens; and the undersigned
     hereby warrants and agrees to indemnify the City from any inaccuracy of the
     foregoing warranties and representations.

With respect to assignment of warranties, Developer agrees by its execution hereof to assign to the City and warranties it has, express or implied, with respect to those portions of said subdivision to be accepted by the City by its approval herein.

IN WITNESS WHEREOF, the undersigned has duly executed this document on the
_________ day of ___________, 20_____.
                                                            PETITIONER:
                                                            ____________________________
             (notarize)                                 Company
                                                             By:
                                                             ____________________________
                                                             Signature                       Title