2003/10/15 Council Agenda Packet

CffY OF EVERE'IT 6 FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Road Runner Striping ADDRESS: 10611 Canyon Rd E#122 CITY: Puyallup STA IE: WA 98375 DATE: September 12, 2003 PROJECT TITLE: 2003 Pvement Marking WORK ORDER NO. 3149 DA IE WORK COMPLE I'E: August 18, 2003 FINAL AMOUNT: $ 32,822.75 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 aris'ng out of the performance of said contract, which are not set forth in said estimate. X Z-- X ere clfe :,,,,,,„, CONTRACTO TITLE �StlM�O Road Runner Striping �` ��y ' -I OA Subscribed wid swo before pieu&v' me this my of �` ASIV10$ ;X ?DG`� ' Notary ' clic � � �....�in and for the State of Washington, res ing at t v� �d U h y ost . 'VIII ir4.1 �' Nittriffinie _ j- a V PUBLIC W I '.'S DEPARTMENT CERTIFICATION 11 I Certify the attached final APPROVED Date: l :3 ---°3 estimate to .- based upon actual measures and t• be true and correct. X t — !A i / x 2'-r 9 i 1 3' Cons; s 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 30