2008/09/24 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR:Rinker Materials dba Cemex CITY: Everett STATE: WA 98213 PROJECT TITLE: 2007 Hot Mix Asphalt Overlay DATE WORK COMPLETE: July 17, 2008 ADDRESS: PO Box 2037 DATE: August 26, 2008 WORK ORDER NO. 3291 FINAL AMOUNT: $ 1,759,958.03 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 from any employee . the City; I further certify that the attached final estimate is a true and correct statement showing all the monie i ue e from the City of Everett under this contract; that I have carefully examined said final estimate and une ,. nd that I . ereby release the City of Everett from any and all claims of whatsoever nature he performance of said contract, which are not set forth in said estimate. Xk5TS��t rz y TITLE CONTRACTOR Rinker Materials dba C " ex Subscribed and sworn to before me/ is3 rd At of St Pr 2i c 8 X AL),vii-d. Notary Public in and for the State of Washington, residing at / ► f G�t.c�-d'crtJcsC� PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: 7/1Z 6� estimate to be based upon actual measurements and to be true and correct. Construction Manager Utilities Director Tom Thetford Tom Fuchs 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. Revised 9/94 i�.