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CITY <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/STATE: 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 /> performed 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 estimat- <br /> X _.....diga� _,./ /Al, x aril ri .t. <br /> CONTRACT I TITLE <br /> COrit PA tit <br /> Frank Colucc o Construction raNqi% <br /> 5 � '7.a t tv - <br /> I /SAY ' <br /> Subscribe d swo to before e this 't day of 29Y� � $ <br /> X NM Yo'Vle <br /> Nota Public <br /> 'I'%, ;ter <br /> in and for the State of Washington, residing at "4111-1/ 1Yv Pt" ,`' WASk ` X <br /> r <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to Z,,� <br /> be true and correct. APPROVED Da -: A 0 <br /> X 01-A.Zel, X , <br /> iJiYi!1 <br /> Construction Manager Public Wor ' irector <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 /> Revised 6/2012 <br /> >I <br />