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City of Everett <br /> Construction Management <br /> Affidavit of Amounts Paid DBE Participants <br /> Contractor: Date: <br /> McClure and Sons, Inc. 4/26/2022 <br /> Address: 15714 Country Club Drive City: Mill Creek State:WA r Zip Code: 98012 <br /> Project Title: WPCF Trick ling Filer#1 Media Replacement Project Work Order#: <br /> UP3742-3 <br /> Federal Aid Project Number(if Federally Funded) <br /> Contract Bid Price: DBE Condition of Award: <br /> $ 1,104,454.00 $ -0- <br /> DBE Participant Ethnic Contract Bid Item Amount Paid Participants <br /> Name and Address Code Type No.(s) (Including retainage held) <br /> The Rodriguez Corporation H S 6 $70,977.00 <br /> 7805 SW 40TH AVE <br /> Suite 19031 <br /> Portland, OR 97219 <br /> { <br /> Ethnic Code: Contract Type: Total DBE Participation Achieved <br /> B=Black I=American Indian and S=Subcontractor <br /> H=Hispanic Alaskan Native M=Material Supplier $ $70,977.00 <br /> A=Asian American 0=Other JV=Joint Venture <br /> Affidavit <br /> I,the undersigned, do hereby certify that in connection with all work on the project for which this statement is submitted, <br /> each DBE participant contracted by me has been paid the amounts shown for bid items, or portions thereof, listed. <br /> ��‘�.\\\1MC �U�/i,� Title President <br /> z?.- t JA FAENT . .• L.lgnatire' <br /> •. P4Q?p i'• i' kJ <br /> _ NOTARye��' : Siasscribed and sworn before me this: 10 day of May l 2022 <br /> _ rryye <br /> NSeal y /�LI L <br /> Seal - / Notary Public in and for the State of Washington <br /> ' .i'l j/mw;, residing at Mill Creek,Washington. <br /> THIS FORM IS REQUIRED WITH THE FINAL ESTIMATE <br /> FROM THE PRIME CONTRACTOR ON ALL PROJECTS <br />