2003/04/23 Council Agenda Packet

is FINAL LUN I RAUI VOUCHER CERTIFICATION CONTRACTOR: T. Bailey, Inc. ADDRESS: 12441 Bartholomew Rd , _ CITY: Anacortes STATE: WA 98221 DATE: April 7, 2003 PROJECT TITLE: Olympic Elevated Tank WORK ORDER NO. UT2768-16 _ DATE WORK COMPLETE: March 25, 2003 FINAL AMOUNT:_$.619,949.20 _ CONTRACTOR'S CERTIFICATION 1, 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 of the City; I further certify that the attached final estimate is a true and correct statement showing all the monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may aye, a ' ' out of the performance of said contract, which are not set forth i s imate. X X J . c� _ �3'�5,A _ �`41;:""11:0elof/41.,fio, '"SON F ' F ONTRACTOR TITLE ;``o o�A�'OY T. Bailey,Inc. - s P �\ io; Subscribed an orn t befor r.s� J U B �` me t day f ��',-7?.'+,t,.1.51...>'��.` X Notary Public n ''•, OF W l'?%0%� in and fo t to Washington, residing at � C(nrY -, �L PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: 11 1 C----‘) 3 estimate to be based upon actual measurements and to be true and correct. ..... __,),/ XCL:-A1,4-- l,-, /).44kC_ X -( Construction Manager! Utilities Director Terry Henke Tom Thetford 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 f