2005/06/15 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION J� CONTRACTOR: Pacific Crest Construction ADDRESS: 13619 Mukilteo Speedway CITY: Lynnwood STATE: WA 98037 DATE: May 19, 2005 PROJECT TITLE: Effluent Transfer — Pump Station WORK ORDER NO. UP2880A DATE WORK COMPLETE: May 11, 2005 FINAL AMOUNT: $ 2,228,112.78 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 e sa�. and that I hereby release the City of Everett from any and all claims of whatsoever nature which I hasird out of the performance of said contract, which are not set forth in said estimate_ X X ��Eslo CONTRACTOR TITLE Pacific Crest Construction S 'bed an .= to before _ et his otary Public in ands RY� e o gas V gton, residing at��((; Olds S f�GTF%lt 23 *,# PUBLIC WORKS DEPARTMENT CERTIFICATION OF �/f/H111111111\\\\\` I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. X g 7 X 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 33