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CITY OF EVERETT—2811 WAREHOUSE CONVERSION JANUARY 28, 2015 <br /> CERTIFICATE OF COMPLETION City <br /> CONTRACTOR: Rod McConkey Construction,LLC <br /> ADDRESS: 9225 Otis Beach Street NE <br /> CITY:Olympia STATE: WA DATE:2/18/2016 <br /> PROJECT TITLE: CITY OF EVERETT-2811 WAREHOUSE CONVERSION <br /> DATE WORK COMPLETED: 12/27/2015 FINAL CONTRACT AMOUNT: $546,516.97(Including WSST) <br /> CONTRACTOR'S CERTIFICATION <br /> I,the undersigned,having first been duly sworn,certify that the attached statement is a proper charge for work performed <br /> and material furnished to the City of Everett,that the same or any part thereof has not been paid,and that I am authorized <br /> to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I <br /> further certify that the attached final statement is a true and correct statement showing all the moneys due me from the <br /> City of Everett under this contract;that I have carefully examined said final statement and understand the same and that I <br /> hereby r- -• e the Ci •f Everett from any,and all claims of whatsoever nature which I may have, arising out of the <br /> perform ce o.said c• tract,which are not set forth in said statement. <br /> _. ,`•1••11!at/,,,,,' <br /> CO ETOR TITLE •`�".•''''•p'" <br /> Subscribed and sworn to b, <br /> ~ 'N TAR <br /> me t 's�cl. ox.✓O _ �► • r <br /> X�� ,: , Air Imo,,: ,Notary Public : N= PUBLIC • •k- <br /> in <br /> in and for +'e State of Washington,residing q'' tg <br /> at biZow ./1,1t F ,,,,,,,,t‘v- <br /> Of WAS <br /> FACILITIES DEPARTMENT CERTIFICATION •,,'" <br /> APPROVED Date: 4 .� <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X --A1' —' X <br /> Project an ger Director of Facilities <br /> Chris Lark Mike Palacios <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance /CI(16By: X r <br /> 'YO, • • • / - <br /> Approved as to Form <br /> AT ST: <br /> ity Attorney City Clerk <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor,all subcontractors,and all subcontractor's agents <br /> and forwarded with the Certificate of Completion Certification. <br /> Contractor's Claims,if any,must be included and the Contractor's Certification must be labeled indicating a claim <br /> attached. <br /> CERTIFICATE OF COMPLETION FORM 00 6519 - 1 <br />