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CITY <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: October 12, 2016 ADDRESS: 3120 Hewitt Ave. <br /> CONTRACTOR: Allied Construction Associates,Inc. CITY/STATE:Everett, WA 98201 <br /> PROJECT TITLE: Water Main Replacement P WORK ORDER NO. UP 3598 <br /> DATE WORK COMPLETE: July 27,2017 FINAL AMOUNT: $916,930.35 <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 �t� X . <br /> CON RACT a 0 TITLE <br /> Allied Construction Associates,Inc. ````ot��iri/I�����i' <br /> Subscribe d s orn to before me this 3 day of (2640 lt.17q0 '•.•yo.; <br /> L-Y = <br /> Notary P lic // 2: z / m N, r <br /> in and f r the ate of Washington,residing at SL���� A�. 0y''� QJ (0.: <br /> ° `tt- <br /> ''.�`r '• JVOAC <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: . �. L <br /> X <br /> X lir <br /> M11111 IFF <br /> Construction Manager Public WfrWrIror <br /> Tom Fuchs Dave Da yrs <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 /> Rcviscd 6/2012 <br />