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, <br /> 3 CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Tom- El Construction <br /> ADDRESS: 3908 148th Street SE <br /> CITY: Mill Creek STATE: WA ZIP: 98082 DATE: January 8, 2003 <br /> PROJECT: Fire Station No.6-Additions & Alterations <br /> DATE WORK COMPLETE: Janaaz;c23;28@2 FINAL AMOUNT$658,553.34 <br /> December 23, 2002 (including WSST) <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the above final amount 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 from <br /> any employee of the City; I further certify that the above final amount is a true and correct statement showing all <br /> the monies due me from the City of Everett under this contract; that I have carefully examined said final amount <br /> and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever <br /> nature which I may have, ing out of the performance of said contract, which are not set forth in said final <br /> amount. <br /> --Z, - e:--) i_jfitc..)t- 1.... <br /> CONTRACTOR TITLE <br /> il <br /> Subscribed and sworn to before me this ', day of � �/ , 200 -v <br /> _/. GL' G.,, J/ -,i-/-e-------_ - Notary Public in and for the State of Washington, <br /> rdsiding at r',-vi-;e .- Cl-,,,z__„7,477 <br /> PROPERTY MANAGEMENT DEPARTMENT CERTIFICATION <br /> I Certify the above final amount to be APPROVED Date: . / /B,% a.7 <br /> Based upon actual work performed and <br /> To be true .nd correct <br /> 7----7: " /,-. 7, / <br /> Project Manager, Chris Lark Facilities nager, Mike Shepard <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance By: <br /> Mayor, Frank E. Anderson <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 /> 1. 0 <br />