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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 /> DA IE WORK COMPLETE: July 8,2016 FINAL AMOUNT: $10,948,154.77 <br /> Exclusive of State Sales Tax <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work <br /> performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials <br /> from any employee of the City; I further certify that the attached final estimate is a true and correct statement <br /> showing all the monies due me from the City of Everett under this contract; that I have carefully examined said <br /> final estimate and understand the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said estimate t <br /> iii <br /> X <br /> --"11-4-- X e'S€Ckit <br /> CONTRACTOR TITLE , <br /> Interwest Construction,Inc. <br /> Subscribedd sworn to before me this 21st day of September , 2016 <br /> Xa--kru, at./314,°l, <br /> Notary Public 4 0 <br /> iihfmrrii State of Washington,residing at Bellingham <br /> 04;$ <br /> e�`�a°° ss.,,,,,. . <br /> �i <br /> ��..) ®TA I.2s� <br /> =CO: �O� :c <br /> '.2** .*: PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> Act:° `oOBINC °,•'.,o. <br /> I C-r. g�■- :11_� final estimate to be <br /> bases q}��,r �►4�iieasurements and to <br /> be true and correct. APPROVED Date: \_, 1', L- <br /> X qr/71,- ,j, X / t/ / / , <br /> Construction Manager Public Wf Director <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 <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 /> 44 <br />