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;city <br /> City of Everett 00 6519- 1 <br /> South Precinct Roof Replacement <br /> SECTION 00 6519-CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR:Snyder Roofing of Washington,LLC <br /> ADDRESS: 20203 Broadway Ave. <br /> CITY: Snohomish STATE: WA 98296 DATE:March 23,2020 <br /> PROJECT TITLE: South Precinct Roof Replacement PROJECT NO.342-522 <br /> DATE WORK COMPLETED:December 17,2020 FINAL CONTRACT AMOUNT:$449,242.31 (Including WSST) <br /> CONTRACTOR'S CERTIFICATION <br /> I,the undersigned,having first been duly sworn,certify that the attached statement is a proper charge for work performed <br /> and material furnished to the City of Everett,that the same or any part thereof has not been paid,and that I am authorized <br /> to sign for the claimant;that I have not rented or purchased any equipment or materials from any employee of the City;I <br /> further certify that the attached final statement is a true and correct statement showing all the moneys due me from the <br /> City of Everett under this contract;that I have carefully examined said final statement and understand the same and that I <br /> hereby release the City of Everett from any and all claims of whatsoever nature which I may have,arising out of the <br /> performance of said contract,which are not set forth in said statement. <br /> X Zif,/ 4,4 ,/ ;f --- ��'�=Naura Albertson-Office Director <br /> GRACTOR 7� ��,'J <br /> o <br /> Subscribed and sworn to before �OTq fif <br /> m this dey of " wa.0 E. v, <br /> XLitligoo Ai .,pb.,, Notary Public U$L 1C <br /> in and for the State of Washington,residing%7), 0 at <br /> • �Jff �f •air, <br /> AS <br /> DEPARTMENT CERTIFICATION <br /> APPROVED Date: 411//o <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. g..../4.4,XProro e�er� X Director <br /> ADMINISTRATION USE ON <br /> Date of Acceptance By: X <br /> C. yor <br /> Appr the <br /> Office of the City Attorney AT*: <br /> � �. <br /> APPROVED AS TO FORM !�1 <br /> X David C.Nall,City Attorney el��� � <br /> G' City Clerk <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 00 6519 <br /> 00 65 19- 1 CERTIFICATE OF COMPLETION FORM <br />