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CITY OF EVERETT <br /> 5 FINAL CONTRACT VOUCHER CERTIFICATION <br /> 2'ONTRACTOR: Advanced American Diving Services, Inc. ADDRESS: P 0 Box 1630 <br /> 2ITY: Oregon City STATE: OR 97045 DATE: February 10, 2005 <br /> PROJECT TITLE: Emergency Water Transmission Pipeline Repairs WORK ORDER NO. UP3148 <br /> DATE WORK COMPLETE: November 20, 2004 FINAL AMOUNT: $ 1,076,433.20 <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 /> and 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 /> employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may have, arising out of the performance of said contract, which are not set forth in said estimate. <br /> CONTRACTOR TITLE <br /> J � � � OFFICIAL SEAL <br /> C �,^ LISA J. ROSE (` <br /> Advanced American Diving Services,Inc. (� -� NOTARY PUBLIC-OREGON 111 <br /> ) N„- COMMISSION NO.386034 <br /> ' <br /> Subscribe, and sworn t+ •efor ( M1'COMMISSION EXPIRES NOVEMBER 16.2008: <br /> meth” ; ;y`,;, �/ (_ _ . . <br /> raw',: Vr Notary Public , !l �y <br /> .no for the(tate of , residing at 6f4 dyfiVii't-(y <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: ��SLI/Or <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> je44 F <br /> . X <br /> Constru ' ion Manager Utilities Director <br /> Jenifer Galatas 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 /> Contractor'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 /> 11 <br />