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4 <br /> CITY OF EVERETT • <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: August 12, 2016 ADDRESS: 9600 ML King Jr. Way S. <br /> CONTRACTOR: Frank Coluccio Construction CITY/STA1B: Seattle WA 98118 <br /> PROJECT TITLE: Transmission Line#5—Pilchuck River WORK ORDER NO. UP 3251 <br /> DATE WORK COMPLETE: July 28,2016 FINAL AMOUNT: $3,609,685.62 <br /> Exclusive of State Sales Tax <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work <br /> perfoimed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials <br /> from any employee of the City; I further certify that the attached final estimate is a true and correct statement <br /> showing all the monies due me from the City of Everett under this contract; that I have carefully examined said <br /> final estimate and understand the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said estimate. <br /> X X d� /VAC- ,.,,L, <br /> ONTRAC ► I R TITLE F', p 44, <br /> 11 <br /> • Frank Col cio Construction /2,01 (pti <br /> i 0 tt <br /> Subscribe. . .d sworn to before me this lit day of W611444,112.!2.04-5-- ' ---14 . : <br /> /� tea Rex <br /> t <br /> X / IA�� _fie, 1i_18 <br /> No . Public \n/ - WASI-ks_ <br /> in and for the State of Washington,residing at Y•41/ <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to <br /> be true and correct. APPROVED Date: 41/ <br /> x Wr714,42 x. 0 <br /> , 1 / i <br /> Construction Manager Public W•F wbir c or v ' <br /> Tom Fuchs Dave Davis <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> agents and forwarded with the Final Contract Voucher Certification. <br /> Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> attached. <br /> 10 <br /> Revised 6/2012 <br />