Laserfiche WebLink
CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: July 13, 2020 ADDRESS: P.O. BOX 507 <br /> CONTRACTOR: SRV Construction CITY/STATE: Anacortes, WA 982221 <br /> PROJECT TITLE: Water Main "Q" Evergreen Rebid WORK ORDER NO. UP 3664 <br /> DATE WORK COMPLETE: May 13, 2019 FINAL AMOUNT: $1,696,100.66 <br /> Exclusive 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 a d all claims of whatsoever nature which I may have, arising out of the performance of <br /> aid contract, , are not set forth in said estimate. <br /> 1 <br /> x k.N . _......„ <br /> 1 . <br /> I . x � . . .z_AnAL� • <br /> CO' ' . TO • TITLE . <br /> SRV Construe ': . C•SNP\\U <br /> DNA LA41 I1 <br /> Subscribed and sworno before me this 14th day of July, 2020. i G�ss‘ONF+e Ili <br /> ZGLeoor • <br /> ��o4 ()TA/O : ' <br /> ry Public / 00 <br /> AVBLAG ;2 <br /> in and for the State of Washington, residing at Skagit County. �/ Ny,;•°s to_20ti�.��� i <br /> ,111,OF WASH*- = <br /> \u.- -�� <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 Dater 7'Z g-7-0ry <br /> X T11417aCALX_ <br /> Construction Manager Pub Works Director <br /> Tom Fuchs Ryan Sass, P.E. <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 />