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1.,11 T U1' t V tKt 1 1 <br /> ,, REVISED FINAL CONTRACT VOUCHER CERTIFICATION <br /> J <br /> CONTRACTOR: Rinker Materials ADDRESS: P 0 Box 2037 <br /> CITY: Everett STATE: WA 98203 DATE: January 28, 2003 <br /> PROJECT TITLE: 2002 Asphalt Concrete Overlay WORK ORDER NO. PW3097 <br /> DATE WORK COMPLETE: October 31, 2002 FINAL AMOUNT: $ 1,218,587.68 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any <br /> employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may have, arising out of the performance of said contract,which are not set forth in said estimate. <br /> X ,,QLc_ roc-05k-\. _ X Asst Secretary <br /> CONTRACTOR TITLE <br /> Rinker Materials <br /> C);'_ ..,:''''' �'J'''\ <br /> 4 .i i:islU 7 <br /> Subscribed and worn to before G„ ,' NF G <br /> me is 29th d of January 2003 () vo. -fes (; 1 <br /> X ( : tJvt c.c- Ct-tna Notary Public (cf) f49y rn <br /> in and for the State of Washington, residing at Marysville ! `s.A/'0Clc <br /> \ oma^ X04 <br /> 5 <br /> PUBLIC WORKS DEPARTMENT CERTIFICA ION <br /> I Certify the attached final APPROVED Date: Z 3-a3 <br /> estimate to be based upon actual <br /> measure's- . s and to b- true and correct. <br /> �_ ",/ -1)r I/v-{) <br /> X <br /> Cons tion Manager Utilities Director <br /> Terry Henke Tom Thetford <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 9/94 <br /> iY <br /> a <br />