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CITY <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: September 20, 2016 ADDRESS: 609 North Hill Blvd. <br /> CONTRACTOR: Interwest Construction Inc. CITY/STATE: Burlinton, WA 98233 <br /> PROJECT TITLE: Sewer System M Phase 1 Project WORK ORDER NO. UP-3470 <br /> DATE WORK COMPLETE: July 8, 2016 FINAL AMOUNT: $10,948,154.77 <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 estim e <br /> a,X X re-td,‘ <br /> CONTRACTOR TI'11,E <br /> Interwest Construction,Inc. <br /> Subscribe and sworn to before me this 21st day of September , 2016 <br /> X a----ft (,f <br /> No ublic <br /> uwit <br /> `, i � S <br /> _tate of Washington, residing at Bellingham <br /> *• OTAftfr•as NZ— <br /> u)• moo® •O_ <br /> � '• 0130%, �i� PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> 200°`'0�`��� <br /> I Ce�IA/Q�final estimate to be <br /> based upolli measurements and to <br /> be true and correct. APPROVED Date: to I <br /> X .•C uaZ:L X lI // <br /> Construction Manager Public frw Msec. <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 />