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CITY OF EVERETT <br /> 4 FINAL CONTRACT VOUCHER CERTIFICATION <br /> :ONTRACTOR: KLB Construction,Inc. ADDRESS: P 0 Box 158 <br /> ,TTY: Mukilteo STATE: WA 98275 DATE: July 12,2004 <br /> 'ROJECT TITLE: Interurban Trail (Madison to 44th) WORK ORDER NO. 2857 <br /> )ATE WORK COMPLETE: June 29, 2004 FINAL AMOUNT: $739J-84.96 <br /> q' 7a,,043.4-e L' > <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 /> Ind 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 /> :mployee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> nonies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> inderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> vhich I may ave, arising out .f the performance of said contract, which are not set forth in said estimate. <br /> ALA41 'UC PRESIDENT�ONT ' - t TO 'f • A TITLE <br /> [(LB Constructi i u,I ►. <br /> iubscribee ano o b ore 2 ;sossION F tir\ <br /> da <br /> ne th's y o +A <br /> is ! otary Public (--) <br /> �� `' No-1;4/1y9N <br /> n and or the State •f W. ington, residing at <br /> pUE�IC <br /> -7j, i1-15-2004 = <br /> op WASN\� <br /> PUBLIC WORKS DEPARTMENT CERTIFICATIO <br /> Certify the attached final APPROVED Date: 7 vq <br /> :stimate to be based upon actual <br /> neasure -is and to be true and correct. <br /> Cons e tion 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 /> Tontractor'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 /> 7 <br />