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City of Everett 00 6519- 1 <br /> Evergreen Branch Library Expansion 2017-008 <br /> SECTION 00 6519-CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: Faber Construction Corp <br /> ADDRESS: 131 East Grover Street <br /> CITY: ynden STATE: WA DATE:3/2/202( <br /> PROJECT TITLE: Evergreen Branch Library-Expansion PROJECT NO.2017-008 <br /> DATE WORK COMPLETED: 2/29/2020 FINAL CONTRACT AMOJNT:$ 5,248,803.48 <br /> CONTRACTOR'S CERTIFICATION <br /> I,the undersigned,having first been duly sworn,certify that the attached statement is a proper charge for work performed <br /> and material furnished to the City of Everett,that the same or any part thereof has not been paid,and that I am authorized <br /> to sign for the claimant;that I have not rented or purchased any equipment or materials from any employee of the City;I <br /> further certify that the attached final statement is a true and correct statement showing all the moneys due me from the <br /> City of Everett under this contract;that I have carefully examined said f nal statement and understand the same and that I <br /> hereby release the City of Everett from any and all claims of whatsoever nature which I may have,arising out of the <br /> performance of said contract,which are not set forth in said statement. <br /> x x Sr. Project Manager <br /> CONTRACTOR TITLE _ _ <br /> o . <br /> ,4NGIE CIBERT <br /> Su scribe and sworn to before <br /> Notary Public <br /> t i • daypf (l IOU State of Washington <br /> I-t.�.(E - Notary Public License Number 193332 <br /> in rthe State of Washington,residing My Commission Expires . <br /> at t tU'lv1�1 June 01,2021 <br /> 4 <br /> DEPARTMENT CERTIFICATION <br /> APPROVED Date: v SY <br /> I Certify the attached final <br /> statement to be true and correct <br /> to st of my wledge. <br /> Xal , <br /> 7x <br /> roject Manager Director <br /> ADMINISTRATION USE ONLY,.— <br /> p 4-)- dam By: X _. <br /> Date of Acceptance <br /> Cassie nklin,Ma <br /> Appro a of the City Attorney S t ; <br /> APPROVED AS TO FORM �]�� <br /> x David C.Hall,City Attorney '1 <br /> City Attorney City lerk <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor,all subcontractors,and all subcontractor's agents <br /> 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 11-03 <br /> END OF SECTION 0013519 <br /> 00 6519- 1 CERTIFICATE OF COMPLETION FORM <br />