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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION •- 3 <br /> CONTRACTOR: Allied Construction Associates, Inc. <br /> ADDRESS: 3927 Colby Avenue <br /> CITY: Everett STATE: WA. DATE: 24 May, 2004 <br /> PROJECT 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 /> I, the undersigned, having first been duly sworn, certify that the attached statement is a proper charge for work <br /> performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that 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 /> °^ h l- [ out of thesaid contract, which ^rte not.set forth in <br /> whatsoever nature which I 1 may have,C, dl illi ly performance ivv of Jcav ,,.� <br /> said statement. <br /> ' e <br /> X �(L X Vm4-t_66-± <br /> CONTRACTO <br /> F 1 TITLE <br /> Subscribee4l and swo n to befpre ��:��""""'�;,, <br /> this 3 day wit 4/01f �•``�o�P.....� <br /> • <br /> X Notary Public • 'p�"'"ss)Qti-.A. 9..‹, <br /> • <br /> in an f the State of Washington, resiling nor-4/4. :r <br /> GyAU$1 to • <br /> PARKS AN Cf RE.at1_* 'ARTMENT CERTIFICATION <br /> WA S H% \‘ <br /> APPROVED."' <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X ) r % L sG�- X <br /> Project Man' er 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 subcontracto 'l <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 02-94 <br />