2005/05/25 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Marshbank Construction ADDRESS: P 0 Box 97 CITY: Lake Stevens STATE: WA 98258-0097 DATE: April 11, 2005 PROJECT TITLE: 112th St. SE Improvements, Phse 1 WORK ORDER NO. 2440, 3051 DATE WORK COMPLETE: March 11, 2005 FINAL AMOUNT: $ 559;050763 ki 41020;71(o . Os CONTRACTOR'S CERTIFICATION I, the undersigned, having first been duly sworn, certify that the attached bill 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 attached final estimate 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 estimate and understand the same and that I hereby release the City of Everett from an . d"aU,tclaims of whatsoever nature which I ma have arising out of the performance of said contract, which ark J .f t 'irk said estimate. X • P I I CONTRACTOR TITLE y c :o NOTARY m0 Marshbank Construction PUBLIC � r„ 22 oCD /A:°: Subscribe. and sworn to befo e e this day of V �� �'��. WASH\ 4..LJ lin 11. . �gimp otary Public in and for the State o Washington, residing atSafitalkAJAk. �'' ' PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. X 5,02.cie2, X 31 z7r) Construction Manager Utilities Director Tom Fuchs 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