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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: June 21, 2019 ADDRESS: 609 N. Hill Boulevard <br /> CONTRACTOR: Interwest Construction, Inc. CITY/STATE: Burlington,WA 98233 <br /> PROJECT TITLE: Watermain Replacement"T" Project WORK ORDER NO. UP-3684 <br /> DATE WORK COMPLETE: May 2, 2019 FINAL AMOUNT: $2,308,118.72 <br /> Including Washington 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 <br /> paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment <br /> or materials from any employee of the City; I further certify that the attached final estimate is a true and <br /> correct statement showing all the monies due me from the City of Everett under this contract; that I have <br /> carefully examined said final estimate and understand the same and that I hereby release the City of <br /> Everett from any and all claims of whatsoever nature which I may have, arising out of the performance of <br /> said contrac w ich are no forth in said estimate. <br /> X X President <br /> CONTRACTOR TITLE <br /> Interwest Construction, Inc. <br /> Subscribed and sworn to before me this 20th day of June. 2019 NoKA ////// <br /> /®/� i�� <br /> cl< <br /> Notary blic _n� � *O A y �, <br /> In and for the State of Washington, residing at Bellingham *• ®O�' :* <br /> cP: pU6 LSC ***V. <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION iFO/ iAS0�i N �� <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to <br /> be true and correct. APPROVED Date: /D-Z J—20 c <br /> Construction Manager PublicWorks Director <br /> Tom Fuchs Ryan Sass <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all <br /> subcontractor's 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 <br /> claim attached. <br /> Revised 6/2012 <br />