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10 <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: June 25, 2013 ADDRESS: PO Box 481 <br /> CONTRACTOR: SRV Construction CITY/STATE: Oak Harbor WA 98277 <br /> PROJECT TITLE: Water Main Improvement"K" WORK ORDER NO. UP 3443 <br /> DATE WORK COMPLETE: February 1, 2013 FINAL AMOUNT: $2,492,919.77 <br /> (Exclusive of State Sales Tax) <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work <br /> performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials <br /> from any employee of the City; I further certify that the attached final estimate is a true and correct statement <br /> showing all the monies due me from the City of Everett under this contract; that I have carefully examined said <br /> final estimate and understand thes. ..,d th_ -re. ---.i.e the City of Everett from any and all claims of <br /> whatsoever nature w.'ch • . ;.— . -'i- or-t performance of said contract, which are not set forth in <br /> said estimate. <br /> _�_' X ///1^iv ,-,T <br /> LC_e <br /> COST '4F CTOR TTTLE 1 <br /> SRV Construction NOTARY PUBLIC <br /> STATE OF WASHINGTON <br /> BLAKE A THORN <br /> Subscribed and sworn to before e 's 6 day of - I 201=My Appointment Expires Oct.05,2013', <br /> X `^ �,J, , c1I <br /> otary Public <br /> in and for the State of Washington,residing at r/e,_,e ,,_,Y 4.fu 47 J <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to Ak <br /> be true and correct. APPROVED Date: <br /> X Z , 4//ARP <br /> � . . <br /> onstruction Manager I Public Wor , i irec ' r <br /> Tom Fuchs ' ' Dave Davis <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> agents and forwarded with the Final Contract Voucher Certification. <br /> Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled-indicating a claim <br /> attached. <br /> Revised 6/2012 <br /> 41 <br />