2014/10/08 Council Agenda Packet

5 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION DATE: September 3,2014 ADDRESS: 20700 4461-Ave W., Suite 240 CONTRACTOR: Cemex CITY/STATE:Lynnwood WA 98036 PROJECT TITLE: 2013 Hot Mix Asphalt Overlay FINAL ORKORDER DERNO. PW$2,339,5 22 DATE WORK COMPLETE: June 9,2014 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 froth 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. Mark Baker-Vice President/Gen. Mgr. X —71K--"f CONTRACTOR TITLE Centex CEMEX Con5tiUCtiQ ,. 'als Pacific LLC sT1184. Subscribed and sworn to be` {= t . .' ay of .Lfli X .;� Notary Public ' - v -4` z in and for the State o —Stelae-a- Pi-PC d,�io'ix t oF P7,/,70,6-P/b— PUBLIC WORKS DEPARTMENT CERTIJ ICATION I Certify the attached final estimate to be based upon actual measurements and to 0 be true and correct. APPROVED Date; !-1 X. ,./14,J " X AdL Construction Manager Public Worts Director( Torn 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. Revi:^_d 5/2C 13 18