2013/10/16 Council Agenda Packet

1 • 2 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION DATE: Sept. 19,2013 ADDRESS: PO Box 358 CONTRACTOR: Shoreline Construction CITY/STATE: Woodinville WA 98072 PROJECT TITLE: Lift Station 24 Force Main(Silver Way Seg) WORK ORDER NO. UP 3534 DATE WORK COMPLETE: August 2, 2013 FINAL AMOUNT: $154,957.65 (Exclusive of State Sales Tax) CONTRACTOR'S CERTIFICATION I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in said estimate. . ` / et= r TO ' TITLE Shoreli 'e Construction Subscri d and sw to before me this .V•40 day of 5�L -rn bt , 2013 �KALO0 44 _ If j1J2--,,A ec-2._ Notar�Public U " . _�` u= j f.; N; _ in and for the State of Washington, residing at _i-_c , Y� /-5-k-- .".% .Os ‘o 2 PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final estimate to be based upon actual measurements and to • be true and correct. APPROVED Date: . _if X � X 4tow /LIW Construction Manager Public :"'s Director • Tom Fuchs Dave Davis INSTRUCTIONS The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with the Final Contract Voucher Certification. Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 6/2012 62