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Lit T yr r.Vriw,l 1 , <br /> FINAL CONTRACT VOUCHER CER TIt ICATION <br /> 3 <br /> ONTRACTOR: Potelco,Inc. ADDRESS: 14103 8th St. E <br /> [TY: Sumner STATE: WA 98390 DATE: October 5, 2004 <br /> 2OJECT TITLE: Wetmore/Hoyt 1-Way to 2-Way Conversion WORK ORDER NO. 3088,3089,3089A,3076 <br /> ATE WORK COMPLETE: May 9, 2004 FINAL AMOUNT: $ 1,195,752.83 <br /> CONTRACTOR'S CERTIFICATION <br /> the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> id material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> ithorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any <br /> nployee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> onies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> iderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> hich I may have, aril' t t of the performanc1ejo�f said contract,which are not set forth in said estimate. <br /> O RACTO ' TITLE <br /> fit' co,Inc. ♦‘`‘,`` Jr,�7 ,'.'iii <br /> ' �7J <br /> J �" <br /> ubscribedand sworn before <br /> ie this % da .f o <br /> Notary Public d • 7�Suer: <br /> . • s .'ort,• :mate of Washington, residing at �;�Q <br /> S <br /> 38 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> Certify the attached final APPROVED Date: <<' _ly.� <br /> ;timate to be based upon actual <br /> Leasure, • is and to lie true and correct. <br /> Cons.•i tion Manager Utilities Director <br /> Terry Henke Tom Thetford <br /> INSTRUCTIONS <br /> he Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> vents and forwarded with the Final Contract Voucher Certification. <br /> ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> tached. <br /> evised 9/94 <br />