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Exhibit A - Continued <br />CITY MAP CHECK AGREEMENT D07 -028 <br />SAMPLE FORMAT CERTIFICATES <br />SAMPLE FORMAT #4 - CITY ENGINEER'S STATEMENT <br />(TRACT AND PARCEL MAPS) <br />I hereby state that I have examined this map and found it to be substantially the same as it <br />appeared in the tentative map, if required, as filed with, amended and approved by the City Planning <br />Commission; that all provisions of the Subdivision Map Act and City Subdivision Regulations have been <br />complied with. This statement will be effective on the date upon which the County of Orange approves <br />the map as technically correct. <br />Dated this day of <br />(Print Name / Title) (Signature) <br />of <br />R.C.E. # <br />My registration expires <br />SAMPLE FORMAT #S - CITY CLERK'S CERTIFICATE <br />(TRACT AND PARCEL MAPS) <br />I hereby certify that this map was presented for approval to the City Council of the City of at a <br />regular meeting thereof on the day of 200_ and that thereupon said <br />Council did, by an order duly passed and entered, approve said map and did accept on behalf of the <br />public, subject to improvements; the dedication for street purposes of <br />name), and did also accept on behalf of the City of , said approval to be <br />effective upon the approval of the map by the County of <br />1. The storm drain system and appurtenances as dedicated. <br />2. The domestic water system and appurtenances as dedicated. <br />3. The sanitary sewer system and appurtenances as dedicated. <br />4. The subsurface water rights as dedicated. <br />2of3 <br />