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3 CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DONTRACTOR: Allied Construction Associates, Inc. <br /> %DDRESS: 3927 Colby Avenue <br /> :,ITY: Everett STATE: WA. DATE: 24 May, 2004 <br /> DROJECT TITLE: Forest Park Administration Building Remodel PROJECT NO. PK581-1 <br /> DATE WORK COMPLETED: 24 May, 2004 FINAL CONTRACT AMOUNT: $612,747.53 <br /> CONTRACTOR'S CERTIFICATION <br /> the undersigned, having first been duly sworn, certify that the attached statement is a proper charge for work <br /> Derformed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> :hat I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from <br /> any employee of the City; I further certify that the attached final statement is a true and correct statement showing <br /> all the moneys due me from the City of Everett under this contract; that I have carefully examined said final <br /> statement and understand the same and that I hereby release the City of Everett from any and all claims of <br /> vJhats oeVCr nature which i riay have, arising out <br /> of the <br /> performance of said contract, which are nGI set forth <br /> n i(7 <br /> said statement. <br /> CONTRACTOR TITLE <br /> `��uiiiir►rr <br /> pS <br /> Subscribe and sworn to before `�`�\o$......:to%:„ <br /> e this 3�day of 1-sen t. Zoo 1 � <br /> X (� i� Notary Public r NOTgq` `-P�N e� <br /> in and or the State of Washington, rEsiccing ®. <br /> at circ ; aO \c • <br /> PARKS ANDI-Nwr-.~:IpkwiDEPARTMENT CERTIFICATION <br /> APPROVED Date: <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> }X - X -4/-:2&:71 ..t/tr-14444(1 <br /> Project Manage Director of Parks and Recreation <br /> Henry F. Schroder Susan Francisco <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance By: X <br /> MAYOR Ray Stephanson <br /> Approved as to Form <br /> X <br /> City Attorney <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..- 1 <br /> Revised 02-94 <br />