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CITY <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: September 19, 2016 ADDRESS: 13600 44th Street NE <br /> CONTRACTOR: Thomco Construction, CITY/STATE: Lake Stevens, WA 98258 <br /> PROJECT TITLE: Shore Avenue Storm Water Outfall Imp. WORK ORDER NO. UP3118 <br /> DATE WORK COMPLETE: August 10, 2016 FINAL AMOUNT: $1,919,191.94 <br /> Exclusive of State Sales Tax <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work <br /> performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials <br /> from any employee of the City; I further certify that the attached final estimate is a true and correct statement <br /> showing all the monies due me from the City of Everett under this contract; that I have carefully examined said <br /> final estimate and understand the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said estimate. <br /> CONTRACT' ' ebmtAms -400\- TITLE <br /> Thomco Construction Vc, Pt/fr.-4 <br /> Subscribed and sworn to before me this day of OLTDQ - <br /> /� Notary Public <br /> X "` 64;16State of Washington <br /> Notary Public SHANA A ROLLINS <br /> in and for the State of Washington, residing at LA-Kr- S e\JE" My Appointment Expires Aug 30,2017 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to <br /> be true and correct. APPROVED Date: (D Ad►' <br /> X , X <br /> sill <br /> ' r <br /> Construction Manager Public FIFtS''�J r �� <br /> Tom Fuchs Dave Davis <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 6/2012 <br />