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vl 1 1 L♦L1W J. 1 <br /> 5 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Stripe Rite,Inc. ADDRESS: P 0 Box 1724 <br /> CITY: Auburn STATE: WA 98071 DATE: September 16, 2004 - <br /> PROJECT I'i'1'LE: 2004 Pavement Marking WORK ORDER NO. 3181 <br /> DA I'E WORK COMPLETE: August 18, 2004 FINAL AMOUNT: $ 31,277.15 <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 /> 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 y,.,...th..Eits,oever nature <br /> which I m. , have, an ing out of the performance • said contract, which are not set forth in said eiate. <br /> 0 - i <br /> / <br /> ONTRACTOR TITLE - =,�Q�5'7'\SSIo <br /> Stripe Rite,Inc. s V:' Not --o• <br /> � � •� m- ; <br /> Subscibed nd sworn�,�"to before % UsLic �:m- 'r,' da ofSei ._7/ �'. /.1 Notary Public ��`�� p�2?9:0 •'�o <br /> i. .nt( 11r t i tate of Washington, residingat f'.ezc_(jL. �Qj Ck ''4,,�WgsHiNG <br /> PUBLIC WORKS DEPARTMENTgCERTIFICATION <br /> I Certify the attached final APPROVED Date: `-241"°y <br /> estimate to 140, based upon actual <br /> measure `l's and to by' e and correct. <br /> X <br /> �.rirx � X/ . <br /> Cons v,c ion 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 /> 1. 0 <br />