2004/08/18 Council Agenda Packet

FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Wilder Construction ADDRESS: 3315 - 15th Street • CITY: Everett STATE: WA 98201 DATE: July 12,2004 PROJECT TITLE: Evergreen Way—41st to 47`t' WORK ORDER NO. 2981 DATE WORK COMPLETE: June 18, 2004 FINAL AMOUNT: $ , , • .1,2`i61B'7.Z 7' 0 I CONTRACTOR'S CERTIFICATION G[/,1DEJUL 2004 R CONr [, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for workR 1 LQN► ed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I further certify that the attached final estim..- , true and correct statement showing all the monies due me from the City of Everett under this _. •tract; that have careful y examined said final estimate and understand the same and that I hereby release the Ci• o .. - - tt from any and all claims of whatsoever nature which I may have, arising out of the performance of%le c• t :. •. •ich are not set forth in said estimate. X X CONTRACTOR TITLE Andrew B. Thompson, Area Manager Wilder Construction Subscrib A and sworn,to befo itier4, da of .41 X Mirr1 , A .MITI, Notary Public in and fort e :to of ash i • , residing at 1 Ly1C3 PUBLIC WORKS DEPARTMENT CERTIFICATION [ Certify the attached final APPROVED Date: 6-6-C)1 estimate to •- based upon actual measures and t t be true and correct. Con ction Manager Utilities Director Terry Henke Tom Thetford INSTRUCTIONS The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with the Final Contract Voucher Certification. Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 9/94