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' CITY OF EVERETT <br /> ,!".. .� FINAI, CONTRACT VOUCFiER CERTIFICATION <br /> CONTRACTOR: Oualitv Air. Znc. ADDRESS: 16705 - 161th Ave. S.E. ' <br /> CITY: Snohomish STATE: Washinaton 98290 DATE: Julv 27 . 1992 , <br /> PROJECT TITLE: Service Center Annex Remodel PROJECT N0. UT00o6 <br /> DATE WORK COMPLETE: Julv 1 . 1992 FINAL AMOUNT: 5 55. 623 . 53 <br /> CONTRACTOR�B CERTIFICATZON <br /> I, the undersigned, having first been duly sworn, certify that the attached <br /> bill is a prope: charqe for work parformed and material furnished to the Cit}� <br /> of Everett, that the same or any part thereof has not been paid, and that I <br /> am authorizad to sign for the claimant; that I have not rented or p�,irchased <br /> any equipment or materials from any employee of the City; I further certify <br /> that the attached final estimate is a true and correct statement showing all <br /> the monies due me from the City of Everett under this contract; that i have <br /> carefully examined said Pinal estimate and understand the same and that I <br /> hereby release �..ha City oP Everett from any and .all c:aims oP whatsoever <br /> nature which I may have, ari'sing out of the performance of said contract, <br /> which are not set forth in said estimate. <br /> 7C�y . X A.t.c.�..'l�— <br /> CONTR7ICTOR TITLE <br /> Subscribed and sworn t before � <br /> me t is _[�day of /99z . ' ' • <br /> X �O.r.+�u.., 7J�• �u.Lu, otary Public ' � . •. <br /> in andD for the State f Washingto�, residing ' <br /> at .�c�c�.-.-. lu�- . • <br /> PDBLZC AORRS DEPARTMENT CERTIFICATION " . <br /> I Certify the attached final APPROVED Date: ' ^ • <br /> estimate to be based upon actual <br /> measure ts and to be true and correct. <br /> }C_ ` ' X ' . <br /> Con uct on Manager � D rector o u 1 c Works <br /> Terry Henke - Kenneth C. Housd.en <br /> • ADMINISTRATION 08E ONLY <br /> Date of Acce�itance By: X <br /> MAYOR Pete Kinch <br /> INSTRDCTIONS <br /> The Affidavit of Wages Paid must be pregared by the prime contractor, all <br /> subcontractors, and all subcontractor's agents and forwarded with the Final <br /> Contract Voucher Certification. <br /> Contractor�s Claims, if any, must be included and the Contractor's <br /> Certification must be labeled indicating a claim attached. <br /> Revised 5/92 <br /> 6 <br />