2004/07/14 Council Agenda Packet

CITY OF EVERETT 3 FINAL CONTRACT VOUCHER CER IIFICATION ONTRACTOR: Tri State Construction ADDRESS: P 0 Box 3686 ITY: Bellevue STATE: WA 98009-3686 DATE: June 22, 2004 ROJECT TITLE: Effluent Transfer-Pipeline WORK ORDER NO. UP2880B ,ATE WORK COMPLETE: April 1, 2004 FINAL AMOUNT: $ 3,745,393.76 CONTRACTOR'S CERTIFICATION the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed ad material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am uthorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any mployee of the City; I further certify that the attached final estimate is a true and correct statement showing all the conies due me from the City of Everett under this contract; that I have carefully examined said final estimate and nderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature 'hich I o ay have, arising out of the performance of said contract, which are not set forth in said estimate. I .♦ x �t ttS aetv4 'ONTRA TOR TITLE 'ri State Construction `�•‘‘,`,;b4acrll,��i ubscribed and sworn to before :' �`"` P` z ie thjs/ - day of •04- ;NVAL,�, IM--Notary Public = ; O« and for the State of Washington,residing at 171 01l t Wyk ' .r •••- • `�Qte.of ryr; -,`\``. PUBLIC WORKS DEPARTMENT CERTIFICATION Certify the attached final APPROVED Date: 7-1--°11 stimate to be based upon actual neasure• -nts and to be true and correct. ,a x Con -- ction Manager Utilities Director Terry Henke Tom Thetford INSTRUCTIONS -he Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's ,gents and forwarded with the Final Contract Voucher Certification. ,ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. evised 9/94 T 5