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Uii r yr 1vIxr,i I <br /> 4 FINAL CON I"RACT VOUCHER CERTIFICATIONlile <br /> CONTRACTOR: Mike Johnson,Inc. ADDRESS: Rt 7, Box 420 <br /> CITY: Kennewick STATE: WA 99337 DATE: September 29, 2003 <br /> PROJECT TITLE: Pigeon Creek#1 Culvert WORK ORDER NO. 2679 <br /> DATE WORK COMPLETE: June 9, 2003 FINAL AMOUNT: $ 997,980.10 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any <br /> employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> monies due me from the City of-Everett under this contract; that I have carefully examined said final estimate and <br /> understand the same and -at I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may, ave, arisin: out o 'the performance of saidreontract, which are not set forth in said estimate. <br /> ii.-,A _4A4 xp,,,,, ,,,,,,L <br /> O TRACTO ° ir i . TITLE <br /> SW. C1.41 <br /> Mike Johnso•,Inc '�• �ssioN 'O,0O <br /> Subscribed and sworn t before v NOTARr 9Nti <br /> 8 * — )•F— * <br /> met is / sr day ZOO p <br /> X ti 147 4. .a^Notary Public s ' �sL� 1 <br /> in a d for the State of Washington,residing at „ ' i wick; Lf/,4- �-9 '°qic ,s,zo°'��� <br /> v°F Kt—ASO <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> p- 5. <br /> I Certify the attached final APPROVED Date: <br /> -'�7 <br /> estimate to '- based upon actual <br /> measure is and to be true and correct. <br /> , f SP.4:::< / ,iC.,9ley4 <br /> Cons,• ction Manager Utilities Director <br /> Terry Henke Tom Thetford <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> agents and forwarded with the Final Contract Voucher Certification. <br /> Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> attached. <br /> Revised 9/94 <br /> 6 <br />