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Otk <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: December 12, 2019 ADDRESS: 609 North Hill Blvd <br /> CONTRACTOR: Interwest Construction, Inc. CITY/STATE: Burlington, WA 98233 <br /> PROJECT TITLE: Cleveland Avenue Sewer WORK ORDER NO. UP3398 <br /> DATE WORK COMPLETE: December 2, 2019 FINAL AMOUNT: $ 5,771,225.47 <br /> Inclusive 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 <br /> paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment <br /> or materials from any employee of the City; I further certify that the attached final estimate is a true and <br /> correct statement showing all the monies due me from the City of Everett under this contract; that I have <br /> carefully examined said final estimate and understand the same and that I hereby release the City of <br /> Everett from any and all claims of whatsoever nature which I may have, arising out of the performance of <br /> said contract, which are no set forth in said estimate. <br /> X X President ` �� <br /> CONTRACTOR TITLE ,`` ,.KAY O 'os� <br /> Interwest Construction, Inc. . �o�M�SSiOry4Oly/iiS• <br /> OTARy�9�Z <br /> Subscribed and sworn to before me this 23rd day of December, 2019 E co' ®o® •0= <br /> 1 Q4011(4 r <br /> Notary ublic ) �i� ••• N•*() <br /> in and for the State of Washington, residing at Bellingham i�ii►►WAS ��� <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to <br /> be true and correct. APPROVED Dat : -1'2-OZ° <br /> Construction Manager Publ c Works Director <br /> Tom Fuchs Ryan Sass <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all <br /> subcontractor's 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 <br /> claim attached. <br /> Revised 6/2012 <br />