2003/09/17 Council Agenda Packet

CITY OF EVERETT ,r REVISED FINAL CONTRACT VOUCHER CERTIFICATION 4 4, CONTRACTOR: KLB Construction ADDRESS: P 0 Box 158 CITY: Mukilteo STATE: WA 98275 DATE: August 26, 2003 PROJECT TITLE: Sewer Main D Replacement WORK ORDER NO. 3075 DATE WORK COMPLETE: August 11, 2003 FINAL AMOUNT: $ 2,901,174.55 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 s: se an. hat I hereby release the City of Everett from any and all claims of whatsoever nature which I i .v- .risin; .ut of the performance of said contract, which are not set forth in said estimate. X ��' •� KELLY LYNN BOSA �_ / X pRFSIDENT CONT ' • i R ' TITLE � ::Li 4--- ss UNC, KLB Constru F ion \ S F�,o o Subscribend sworn to before2�J o NOTAgy `"u� m_'e,�his 2 day of -p-- ? U,), ,___PUBLIC X Q --- Notary Public . . y), 11-)5-2004 Ap in a d for St4e of Washington, residing at WOCc 4 F c, pF wASO� PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: l'--0-623 estimate to .- based upon actual measure's and to .- true and correct. Const A ction 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 4