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I <br /> City of Everett 00 6519 - 1 <br /> I2022 Biosolids Removal and Disposal UT 3752-30 <br /> 1 SECTION 00 6519 - CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: <br /> IADDRESS: <br /> CITY: STATE: WA DATE:_ <br /> PROJECT TITLE: 2022 Biosolids Removal and Disposal PROJECT NO. UT 3752-30 <br /> IDATE WORK COMPLETED: FINAL CONTRACT AMOUNT: <br /> Is CONTRACTOR'S CERTIFICATION <br /> II, 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 /> I 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 /> I statement showing all the moneys due me from the City of Everett under this contract; that I <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 /> Iarising out of the performance of said contract, which are not set forth in said statement. <br /> X X <br /> CONTRACTOR TITLE <br /> I Subscribed and sworn to before <br /> me this day of <br /> X Notary Public <br /> I in and for the State of Washington, residing <br /> at <br /> IDEPARTMENT CERTIFICATION <br /> APPROVED Date: <br /> I Certify the attached final <br /> I statement to be true and correct <br /> to the best of my knowledge. <br /> I X x <br /> Project Manager Director <br /> I00 6519 - 1 CERTIFICATE OF COMPLETION FORM <br />