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I <br /> City of Everett 00 65 19 - 1 <br /> Police Firing Range Bullet Trap Replacement <br /> I <br /> SECTI <br /> ON ON 00 65 19 - CERTIFICATE OF COMPLETION FORM <br /> I CONTRACTOR: <br /> ADDRESS: 701 I/2 E. Mukilteo Blvd <br /> CITY: Everett STATE: WA <br /> I PROJECT TITLE: Police Firing Range Bullet Trap Replacement <br /> PROJECT NO. <br /> DATE WORK COMPLETED: <br /> 1 FINAL CONTRACT SUM: $ <br /> I CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, certify and declare, under penalty of perjury under the laws of the State <br /> of Washington, that the foregoing is true and correct: I am authorized to sign for the <br /> I claimant; that in connection with the work performed and, to the best of my knowledge, no <br /> loan, gratuity or gift in any form whatsoever has been extended to any employee of the City <br /> Everett, nor have I rented or purchased any equipment or materials from any employee of <br /> I the City of Everett; that the attached final statement is a true and correct statement showing <br /> all the monies due the claimant from the City of Everett for work performed and material <br /> furnished under this Contract; that I have carefully examined said final statement and <br /> I understand the same and; that I, on behalf of the claimant, hereby release and forever <br /> discharge the City of Everett from any and all claims of whatsoever nature which I or the <br /> claimant may have, arising out of the performance of said Contract, which are not set forth <br /> Iin the attached statement. <br /> DATED at this day of , 20 . <br /> I (City, State) <br /> I X X <br /> CONTRACTOR AUTHORIZED TITLE <br /> SIGNATURE <br /> IDEPARTMENT CERTIFICATION <br /> I APPROVED DATE: <br /> I certify the attached final <br /> statement to be true and correct <br /> Ito the best of my knowledge. <br /> X X <br /> I <br /> Project Manager Director <br /> 00 65 19 - 1 CERTIFICATE OF COMPLETION FORM <br /> I <br />