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, <br /> CITY OF EVERETT <br /> 7 FINAL CONTRACT VOUCHER CERTIFICATION • <br /> CONTRACTOR: Stripe Rite, Inc. ADDRESS: P 0 Box 1724 <br /> CITY: Auburn STATE: WA 98071 DATE: July 25, 2005 <br /> PROJECT TITLE: 2005 Pavement Marking WORK ORDER NO. 3227 <br /> DATE WORK COMPLETE: July 1, 2005 FINAL AMOUNT: $ 38,125.75 <br /> CONTRACTOR'S CERTIFICATION <br /> I, 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 'ave, , 's'- out of the performance of said contract, which are not set forth in said estimate. <br /> 110 <br /> • ' . �7•�f r'l TITLE `���� Q N '//� <br /> Stripe Ri e, Inc , •-4t)(1"1141411/,�+0///, <br /> �• �jef <br /> Subscrib-4 i d sworn� ts,ef.re : _v s ,• o g.= z ; <br /> •geth's� 1l: V• �1 ..,, -.KV • ir% , 14 I.:- ' <br /> -- I /// otary �� , ')'►»��������0�? <br /> /i `/iaN �� Public / 6+0 't',,��Q`_ <br /> in and for ti:tate o Washington, residing at ,./. t-l�7' " ils STATE CP , <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: 0I II-1°r <br /> estimate to be based upon actual <br /> measurements and to be true and correct. �'/ <br /> X 0-)';‘)74JA- X <br /> '474 <br /> Construction Manager Utilities Director <br /> Torn Fuchs 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 /> 54 <br />