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4 <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: May 20, 2014 ADDRESS: 2008 East Valley Highway <br /> CONTRACTOR: Petersen Bros. CITY/STAl'E: Sumner WA 98390 <br /> PROJECT TITLE: Everett Citywide Guardrail Improvements WORK ORDER NO. PW 3545 <br /> DATE WORK COMPLETE: April 1, 2014 FINAL AMOUNT: $ 506,305.48 <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 the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said estimat . <br /> X x <br /> CONTRACTOR TITLE <br /> Petersen Bros. <br /> ow iti►►►►0 <br /> Subscribes .nd swo to be .)re me this a. = day of )(11-11-4_ , "` " <br /> 0 201 GPO� �'y °../�. <br /> x /d 4/..t •6�........ <br /> 4 <br /> /0 <br /> co <br /> to: <br /> chary Public =D; AG 4A w <br /> in and for the State of Washington,residing at Suuv ki_e rr, 1A2 ':o !/ `, <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be fc— <br /> based upon actual measurements and to `l <br /> be true and correct. APPROVED Date: <br /> X -7�ZX lam'( � c <br /> 4.7/ <br /> Construction Manager Public Works in-6M <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 /> 14 <br />