2005/06/08 Council Agenda Packet

Lll 1 Vt 1;vracy,11 4 REVISED FINAL CONTRACT VOUCHER CER I'IFICATION ONTRACTOR: Rinker Materials ADDRESS: P 0 Box 2037 TTY: Everett STATE: WA 98203 DATE: May 16, 2005 ROJECT TITLE: 2004 Hot Mix Asphalt Overlay WORK ORDER NO. PW3184 1A1E WORK COMPLETE: December 18, 2004 FINAL AMOUNT: $ 830, 768.40 CONTRACTOR'S CERTIFICATION the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed ❑d material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am athorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any mployee of the City; I further certify that the attached final estimate is a true and correct statement showing all the Ionics due me from the City of Everett under this contract; that I have carefully examined said final estimate and nderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature ,hich I may have, arising out of the performance of said contract, which are not set forth in said estimate. ✓�I lA�l (-0 x °A-. A E f ' et 'ONTRACTOR TITLE sinker Materials • GPR Esq ubscribed and sworn to before o�MNss►°HF� L��' :� l i5? y of (Y1 Ay 2-005 NOTARY N w � Notary Publicp''— ► and for the State of Washington, residing at1/4-10 /. �Bl►C :. X08 WAstilt4 PUBLIC WORKS DEPARTMENT CERTIFICATION Certify the attached final APPROVED Date: Z//t ;timate to be based upon actual ieasurements and to be true and correct. �f . X Construction Manager Utilities Director Tom Fuchs Tom Thetford INSTRUCTIONS he Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's gents and forwarded with the Final Contract Voucher Certification. 'ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim tached. evised 9/94 6