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City of Everett 00 65 19 - 1 <br />SECTION 00 65 19 - CERTIFICATE OF COMPLETION FORM <br />CONTRACTOR: RRJ Compmay, LLC <br />ADDRESS: PO Box 60 <br />CITY: Monroe ______ STATE:WA <br />PROJECT TITLE: Emma Yule Park <br />PROJECT NO. PW2020-064R1 <br />DATE WORK COMPLETED: 10-15-2022 <br />FINAL CONTRACT SUM: $1,174,695.43 <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 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 />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 per formance of said Contract, which are not set forth <br />in the attached statement. <br />DATED at Monroe, WA <br />(City, State) <br />X�W�»u­NTRTOR AUTHORIZED <br />SIGNATURE <br />this 17th <br />x Partner <br />day of October <br />TITLE <br />I 2022 <br />DEPARTMENT CERTIFICATION <br />I certify the attached final <br />statement to be true and correct <br />to the best of my knowledge. <br />x;W� <br />Project Manager <br />00 65 19 - 1 <br />APPROVED DATE: d./�/J3 <br />CERTIFICATE OF COMPLETION FORM