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CITY <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: June 27, 2016 ADDRESS: PO Box 867 <br /> CONTRACTOR: Kamins Construction CITY/STATE: Bothell WA 98041 <br /> PROJECT TITLE: Evergreen Way Pedestrian Walkway WORK ORDER NO. PW 3466 <br /> DATE WORK COMPLETE: May 26, 2016 FINAL AMOUNT: $267,131.16 <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 estimate. <br /> X x res\ <br /> CA4) Ink- <br /> CONTRACTOR TITLE <br /> Kamins Construction gintiIlIusuIIH1111111111111IuuIt11111I11IO <br /> Subscribed and sworn to before me this day of� :t Notary Public <br /> ��� �Qfate of Washington <br /> X Y\ _ CHERYL M. BOSH <br /> Notary P - M NOVEMBER 22E201'RES <br /> in and for the State of Washington, residing at �{1'C s\O r Wpt1111N11111111111111UIttit11t1111111111I tID <br /> PUBLIC WORKS DEPARTMENT CERTIFICAT 1 N <br /> I Certify the attached final estimate to be ! 1 tp <br /> based upon actual measurements and to <br /> be true and correct. APPROVED I te: / <br /> x .0,1/ <br /> Construction Manager Public Wor's Ii ector <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 62012 <br />