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CITY OF EVERETT <br />FINAL CONTRACT VOUCHER CERTIFICATION <br />CONTRACTOR: Road Construction Northwest, Inc. <br />CITY: Renton STATE: WA 98056 <br />PROJECT TITLE: Watermain Replacement "U" Project <br />WORK ORDER NO. UP 3698 <br />DATE WORK COMPLETE: October 9, 2020 <br />ADDRESS: PO Box 2228 <br />DATE: November 30, 2020 <br />FINAL AMOUNT: $1,743,008.51 (includes WSST) <br />CONTRACTOR'S CERTIFICATION <br />1, 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 paid, <br />and that 1 am authorized to sign for the claimant; that I have not rented or purchased any equipment or <br />materials from any employee of the City; I further certify that the attached final estimate is a true and correct <br />statement showing all the monies due me from the City of Everett under this contract; that I have carefully <br />examined said final estimate and understand the same and that 1 hereby release the City of Everett from any <br />and all claims of whatsoever nature which I may have, arising out of the performance of said contract, which <br />are t se 1 for;'h i . t estimate. <br />X. <br />C N, i 1 Cji'UJ[<y TITLE <br />R d Cl6h'striktion Northwest, Inc. <br />Subscribed and sworn to before <br />me this Lz day of Y\Arici <br />X Notary Public <br />in and for the State of}+Yashington, residing at , <br />• ttunti,,,,� <br />\ClA P(/�''�. <br />.P•'R+issr'o� <br />moo 3311 + y <br />;•• <br />..(/\,t/.\,- <br />TA y• <br />:Z <br />cn;rA� �� <br />=—t%�.8LIC <br />aN ry:. <br />`� S H 1NG �� <br />+��� <br />PUBLIC WORKS DEPARTMENT CERTIFICATION <br />I Certify the attached final APPROVED Date: (i' mil' Wz-1 <br />estimate to be based upon actual <br />measurements and to be true and correct. <br />X g31. <br />Construction Manager <br />Tom Fuchs <br />X <br />/ lPtblic Works Director <br />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 9/94 <br />