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2021/12/08 Council Agenda Packet
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2021/12/08 Council Agenda Packet
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12/16/2021 3:30:58 PM
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Council Agenda Packet
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12/8/2021
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CITY OF EVERETT <br />FINAL CONTRACT VOUCHER CERTIFICATION <br />DATE: October 1st, 2021 <br />CONTRACTOR: MERRELL BROS, INC. <br />PROJECT TITLE: 2021BIOSOLIDS & BACKWASH SOLIDS <br />REMOVAL <br />DATE WORK COMPLETE: April 20, 2021 <br />ADDRESS: 8811 W. 500 N. <br />CITY/STATE: Kokomo, IN 46901 <br />WORK ORDER NO. UT 3752 <br />FINAL AMOUNT: $712,177 <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 Everett <br />from any and all claims of whatsoever nature which I may have, arising out of the performance of said <br />contract, which are not set forth in said estimate. <br />x /S! /Q.AL, <br />CONTRACTOR TITLE <br />MERRELL BROS, INC. <br />Subscribed and sworn to before me this <br />x <br />Notary Pi(blic <br />in and for the State of <br />ND LANA <br />n, residing at <br />day of O7--- <br />trilw1/410-04 (thd , <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 corre t. <br />x 7 <br />Project Manager <br />Mike Robinson <br />APPROVED Date: f((Q5 Zot) <br />x <br />Public'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 6/2012 <br />
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