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CITY OF EVERETT' <br /> 4 PHASE 2 FINAL CONTRACT VOUCHER CERTIFICATION <br /> -2ONTRACTOR: •anyftgr-e--- es Olua c 5tt ILT\C, ADDRESS: 4993 Golden Foot Hill Pkwy#2 <br /> i:ITY: Eldorado Hills STATE: CA 95762 DATE: December 29, 2004 <br /> 'ROJECT TITLE: Biosolids &Backwash Solids Removal WORK ORDER NO. UT2600-4, Phase 2 - <br /> )ATE PHASE 1 WORK COMPLETE: August 18, 2004 PHASE 2 FINAL AMOUNT: $ 753,151.18 <br /> CONTRACTOR'S CERTIFICATION <br /> , the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> ind material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> Luthorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any <br /> ;mployee of the City; I further certify that the attached Phase 1 final estimate is a true and correct statement <br /> :bowing all the monies due me from the City of Everett under this phase of the contract; that I have carefully <br /> ;xamined said Phase 1 final estimate and understand the same and that I hereby release the City of Everett from any <br /> ind all claims of whatsoever nature which I may have, arising out of the performance of Phase 1 of said contract, <br /> vhich are not set forth in said estimate. <br /> ___d.Z` X U;c_ �c tcte <br /> 2ONTRACTO ' 1 TI LE <br /> iubscrib_ed nd swo 1 to before \_� �►'"- '''• <br /> i� •=:�• SUE A.GREGORY <br /> ne this cj�y of - ,OC-)0 ;I •) MY COMMISSION EXPIRES <br /> • �. _. Notary Public '` - ' 0 <br /> n and for the State •__ �`' � <br /> =, residing at I —� ... Y1 <br /> 1-1 a u.S�a n ,—[)C l l a<611 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> Certify the attached Phase 1 final APPROVED Date: 9 (2/al <br /> ;stirnate to be based upon actual <br /> neasurements and to be true and orrect. A <br /> C fr'i—'7--etZ, X /.., - <br /> A/C- Tr <br /> Construction Manager IR' • Director <br /> Terry Henke TOM F t.-c-A S • etford <br /> INSTRUCTIONS <br /> 'he Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> gents and forwarded with the Final Contract Voucher Certification. <br /> ;ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> ttached. <br /> revised 9/94 <br /> i4 <br />