2003/10/29 Council Agenda Packet

Ull I or tVtKL1 1 2 FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Rinker Materials ADDRESS: P 0 Box 2037 CITY: Everett STATE: WA 98203 DATE: September 23, 2003 PROJECT TITLE: 2003 Asphalt Concrete Overlay WORK ORDER NO. 3125 DATE WORK COMPLETE: September 23,2003 FINAL AMOUNT: $766,310.81 CONTRACTOR'S CER!'INCATION 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, arising out of the performance of said contract,which are not set forth in said estimate. x (ak ' m x - CONTRACTORS TITLE Rinker Materials NO40 s i. Subscribe nd sworn t be or c Q � ;N `nA. mes I day o 11t, Z o U 3 6 0 X Notary Public N o o a O in and for e State of Washington,residing at L s ? .. VO3 d' dbW PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: to^� estimate to bje based upon actual measure a eats and to true and correct. X x —_) r Cons 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 4