2003/03/05 Council Agenda Packet

LII Y Ur KVt,KLf-1 St FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Tek Construction ADDRESS: 2723 Douglas Rd CITY: Ferndale STATE: WA 98248 DATE: February 4, 2003 PROJECT TITLE: Portal#4 Modification WORK ORDER NO. UT2885 DATE WORK COMPLETE: January 16, 2003 FINAL AMOUNT: $ 1,036,683.83 CONTRACTOR'S CERTIFICATION I, the undersigned, having first been duly sworn,certify that the attached bill is a proper charge for work performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may have, arising out of the performance f said contract, which are not set forth in said estimate. r� X < 1/,,,E,. ,�,,' -• 4/11 CONTRACT TITLE �`P° ; '�:;, Tek Construction : :� • �� yNs . bscribed and sworn to before me is14 y of FEBRUARY 2003 ;ms 's GBL1C X ( �t Notary Public 0 ,,�o:n �� .�•�: in and r the State of Washington, residing at FERNDALE '•.4 �gsH;�G� ..`� PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: Z — ^03 estimate to .e based upon actual measure is and to b- true and correct. Cons": fig x ' ..2)4(19A/71-7'e Cons, tion Manager Utilities Director Terry Henke Tom Thetford INSTRUCTIONS The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with the Final Contract Voucher Certification. Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 9/94