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I <br /> City of Everett 00 6519 - 1 <br /> 111 I <br /> SECTION 00 6519 - CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: <br /> ADDRESS: <br /> CITY: STATE: WA <br /> PROJECT TITLE: Silver Lake Trail <br /> PROJECT NO. 2022 - 075 <br /> DATE WORK COMPLETED: <br /> FINAL CONTRACT SUM: $ <br /> 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 /> ' 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 /> 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 /> understand the same and; that I, on behalf of the claimant, hereby release and forever <br /> idischarge 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 /> in the attached statement. <br /> DATED at this day of , 20 <br /> (City, State) <br /> X X <br /> CONTRACTOR AUTHORIZED TITLE <br /> SIGNATURE <br /> DEPARTMENT CERTIFICATION <br /> APPROVED DATE: <br /> I certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X X <br /> Project Manager Director <br /> 00 6519 - 1 CERTIFICATE OF COMPLETION FORM <br />