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City of Everett 00 6519 - 1 <br /> 2021 Biosolids and Backwash Solids Removal UT 3752-1 / 20 <br /> SECTION 00 6519 - CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: <br /> ADDRESS: <br /> CITY: STATE: WA DATE: <br /> PROJECT TITLE: 2021 Biosolids and Backwash Solids Removal <br /> PROJECT NO. UT 3752-1 / 20 <br /> DATE WORK COMPLETED: FINAL CONTRACT AMOUNT: <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached statement is a <br /> proper charge for work performed and material furnished to the City of Everett, that the <br /> same or any part thereof has not been paid, and that I am authorized to sign for the <br /> claimant; that I have not rented or purchased any equipment or materials from any <br /> employee of the City; I further certify that the attached final statement is a true and correct <br /> statement showing all the moneys due me from the City of Everett under this contract; that <br /> have carefully examined said final statement and understand the same and that I hereby <br /> release the City of Everett from any and all claims of whatsoever nature which I may have, <br /> arising out of the performance of said contract, which are not set forth in said statement. <br /> X X <br /> CONTRACTOR TITLE <br /> Subscribed and sworn to before <br /> me this day of <br /> X Notary Public <br /> in and for the State of Washington, residing <br /> at <br /> DEPARTMENT CERTIFICATION <br /> APPROVED Date: <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X X <br /> Project Manager Director <br /> 00 6519 - 1 CERTIFICATE OF COMPLETION FORM <br />