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City of Everett 00 65 19- 1 <br /> Everpark Garage Repairs 2018-034 <br /> SECTION 00 65 19-CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: F.D.Thomas.Inc. <br /> ADDRESS:7450 S.212th Street { !1291.0 <br /> CITY:Kent STATE: WA 98032 DATE: 42'1 <br /> PROJECT TITLE: Everpark Ga ge Repairs PROJECT NO.2018-034 <br /> DATE WORK COMPLETED: FINAL CONTRACT AMOUNT:$1.436.840.70 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned,having first been duly sworn,certify that the attached statement is a proper charge for work performed <br /> and material furnished to the City of Everett, that the same or any part thereof has not been paid,and that I am authorized <br /> to sign for the claimant;that I have not rented or purchased any equipmentor materials from any employee of the City;I <br /> furthercertifythat the attached final statement's a true and correct statement showing all the moneys due me from the <br /> City of verett underthis contract;that I have carefully examined said final statementand understand the same and that I <br /> hereof": ease the C' of Everett from anyand all claims of whatsoevernature which I may have,arising out of the <br /> perfo• an f . • «• id!ct,which are not set forth in said statement. <br /> i <br /> CONTRACTOR " ! ter <br /> Subsc rib and sw m to fore � /1111214,,oT4,44St <br /> meth'= •ay of i `� 2.41"X t R:► Notary Public tif � � <br /> in an• •r, A.,tate of Washington,residi j <br /> at gepir, 04-tva y‘ svzo <br /> +1, <br /> •�. <br /> DEPA FICATION <br /> APPROVED Date: I/d7f d <br /> I Certify the attached final <br /> statementto be true and correct <br /> to st of my wledge. <br /> X X fAt <br /> Project Manager Director <br /> ADMINISTRATION USE ONLY ..__ <br /> Date of Acceptance a- '62- -I By: X <br /> Cas a Franklin,May' <br /> Approved as to Fo S T: <br /> Office of the City Attorney <br /> APPROVED AS TO FORM ,L <br /> City Attorney ` ` orney <br /> X City Clerk <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor,all subcontractors,and all subcontractor's agents <br /> 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 claim <br /> attached. <br /> Revised 11-03 <br /> END OF SECTION 00 6519 <br /> 00 6519- 1 CERTIFICATE OF COMPLETION FORM <br />