2005/04/06 Council Agenda Packet

4 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Ferrell-Penning, Inc. ADDRESS: 17510 Aurora Avenue North CITY: Shoreline STATE:WA ZIP:98133 DATE:April 6,2005 PROJECT: Police Headquarters—Second Floor Alterations PROJECT NO: NA DATE WORK COMPLETE: January 13, 2005 FINAL AMOUNT $300,650.54 (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 are not set forth in said final amount. CONTRACTOR TITLE Subscribed and sworn to before me this day of ,200_ Notary Public in and for the State of Washington, residing at PROPERTY MANAGEMENT DEPARTMENT CERTIFICATION I Certify the above final amount to be APPROVED Date: Based upon actual work performed and To be true and correct. Project Manager, Chris Lark Facilities Manager, Mike Shepard ADMINISTRATION USE ONLY Date of Acceptance By: 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. 6