2003/10/22 Council Agenda Packet

5 CITY OF EVERETT _.,; FINAL CONTRACT VOUCHER CERTIFICATION _ CONTRACTOR: CDK Construction Services ADDRESS: PO Box 1767 CITY: Duvall STATE:WA ZIP:98019-1767 DATE: October*,2003 PROJECT: Fire Station No.5 DATE WORK COMPLETE: September 19, 2003 FINAL AMOUNT: $2,414,184.08 (including WSST) CONTRACTOR'Sr ERTIFICATION I, the undersigned, having first been duly sworn, certify t the above final amount is a proper charge for work performed and material furnished to the City of Everett, t the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have t rented or purchased any equipment or materials from any employee of the City; I further certify that the above al amount is a true and correct statement showing all the monies due me from the City of Everett under this co act; that I have carefully examined said final amount and understand the same and that I hereby release the of Everett from any and all claims of whatsoever nature which I may have, arising out of the performance said contract, which are not set forth in said final amount. CONTRACTOR TITLE ubscribed and s orn to ,efore me this3r4 day of , , 2003. 4L ,L.,9' , ii a i' !J otary Public in and for the State of Washington, esiding at VOn ro_ PROPERTY MANAGEMENT DEPARTMENT CERTIFICATION I Certify the above final amount to be APPROVED Date: j 8 s Based upon actual work performed and To be true .nd corn t. , ti Project Manager, hris Lark ad ities Ma :ger, Mike hepard ADMINISTRATION USE ONLY Date of Acceptance By: Mayor, Frank E. Anderson 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. I. 2