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SECTION 00 65 19 <br /> CERTIFICATE OF COMPLETION FORM <br /> CONTRACTOR: <br /> ADDRESS: <br /> CITY: STATE: WA <br /> ' PROJECT TITLE: <br /> ' PROJECT NO. <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 of <br /> Washington, that the foregoing is true and correct: I am authorized to sign for the claimant; that <br /> in connection with the work performed and, to the best of my knowledge, no loan, gratuity or gift <br /> in any form whatsoever has been extended to any employee of the City Everett, nor have I <br /> rented or purchased any equipment or materials from any employee of the City of Everett; that <br /> the attached final statement is a true and correct statement showing all the monies due the <br /> claimant from the City of Everett for work performed and material furnished under this Contract; <br /> that I have carefully examined said final statement and understand the same and; that I, on <br /> ' behalf of the claimant, hereby release and forever discharge the City of Everett from any and all <br /> claims of whatsoever nature which I or the claimant may have, arising out of the performance of <br /> said Contract, which are not set forth in the attached statement. <br /> ' DATED at this day of 20 <br /> (City, State) <br /> I 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 /> I <br /> City of Everett 00 65 19-1 February 2023 <br /> WPCF TF1 Bar Screen Upgrades <br /> UP3770 <br /> I <br />