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CITY OF EVERETT <br /> 2 FINAL CONTRACT VOUCHER CERTIFICATION <br /> Ilk <br /> CONTRACTOR: Sturdeweld Construction <br /> ADDRESS: 1004 Commercial Ave#265 <br /> CITY: Anacortes STATE: WA. DATE: 5 September, 2003 <br /> PROJECT TITLE: Swim Center Duct Replacement PROJECT NO. PK3025-6 <br /> DATE WORK COMPLETED: 4 September, 2003 FINAL CONTRACT AMOUNT: $199,716.78 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached statement 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 attached final statement is a true and correct statement showing <br /> all the moneys due me from the City of Everett under this contract; that I have carefully examined said final <br /> statement and understand the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said st tement. <br /> X �� A� <br /> �tC,cc '� .. :� ©a) M-0 <br /> � <br /> CONTRA TOR 4SYM ',. E <br /> --, Ss` <br /> Subscribed and sworn to before jr �-ton f'r'y <br /> s / o f : it'.� 4 d <br /> X :-_, ary P .' / ►,�( .0 0; <br /> in and for the State of Wa hingtor ,'r Oj <br /> at/4 Z, s2 5Kc=-�-�3 -: a'�d�, <br /> -5'V -<_&xi 117C D _. <br /> PARKS AND RECREATION DEPARTMENT CERTIFICATION <br /> APPROVED Date: '- /9"O3 <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X ��ik-.-•.-._ �Y � vim:)c VA-�+- r-Li--- X 62,/ l /� .��Y <br /> Project Manager Director of Parks and Recreation <br /> Henry F. Schroder Susan Francisco <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance By: X <br /> MAYOR Frank E. Anderson <br /> Approved as to Form <br /> X <br /> City Attorney <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> agents ani forwarded with the Final Contract Voucher Certification. <br /> 4 <br /> Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> attached. <br /> Revised 02-94 <br />