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CITY OF EVERETT <br /> 4 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Max Kuney Company ADDRESS: P 0 Box 4008 <br /> CITY: Spokane STATE: WA 99220-0008 DATE: August 15, 2003 <br /> PROJECT TITLE: California Street Overcrossing WORK ORDER NO. 2923 <br /> DATE WORK COMPLETE: August 13, 2003 FINAL AMOUNT: $ 6,472,788.20 <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 that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may have, arising out of the performance of said contract, which are not set forth in said estimate. <br /> XAP( ��jj X Prd,'Gc> Ma.' -teCONTTRAOR TITLE 0111111H41 <br /> •Max Kuney Company ����• ••• H Fg9sso <br /> s�on <br /> J"oF m• <br /> Subscribed and sworn to before `o:0 NoTARk ''? <br /> me this C5 _da of 6c, /,-74e4.),2z .2003 = —•--- <br /> X�a Noary Public '5:cV.: PUB OC 12 <br /> in and for the State of Washington,residing at � ���pP:•�'� <br /> /Inn <br /> ..........► ►1````�� <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: (c1-2"3 <br /> estimate to be based upon actual <br /> measure Aor s and to be true and correct. <br /> X • x <br /> Cons, i 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 />