2005/01/26 Council Agenda Packet

�} 6 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Newland Construction ADDRESS: 3300 Chestnut Street CITY: Everett STATE:WA ZIP: 98201 DATE: January 10, 2005 PROJECT: Everpark Arcade Project DATE WORK COMPLETE: November 19, 2004 FINAL AMOUNT$215,710.4-2 (Including WSST) CONTRACTOR'S CERTIFICATION I,the undersigned, having first been duly sworn, certify that the above final amount is a proper charge for work performed 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 above final amount is a true and correct statement showing all the monies due me from the City of Everett under this contract;that I have carefully examined said final amount and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may have, arising out of the performance of said contract,which .fb not set forth in said final amount. , A.044/170%tt*,, a6tf,f.) CONTRACTOR ,,. +oN.e , ,' " TITLE �° nn .vim= . T Subscribe nd s ► �. �b � rthii E day of JL. ttAtat4200S. ►,:- ti n and for the State bf Washington, residing at eee�' .4 PROP "MANAGEMENT DEPARTMENT CERTIFICATION I Certify the above final amount to be APPROVED Date: _2 z a ,� Based upon actual work performed and To be trr..r`:nd corm 'Project Manager, Scott Pattison Facilities ? ager, Mike Shepard ADMINISTRATION USE ONLY Date of Acceptance By: Mayor, Ray Stephanson 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. 4