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L11 I kir r,vrill✓11 <br /> 3 FINAL CONTRACT VOUCHER CERTIFICATION <br /> 'ONTRACTOR: Rinker Materials ADDRESS: P 0 Box 2037 <br /> TTY: Everett STATE: WA 98203 DATE: September 2, 2005 <br /> 'ROJECT 1'11'LE: 2005 Hot Mix Asphalt Overlay WORK ORDER NO. 3219 <br /> )ATE WORK COMPLETE: August 5, 2005 FINAL AMOUNT: $ 1,265,178.93 <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 /> nd material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> uthorized 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 final estimate is a true and correct statement showing all the <br /> ponies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> nderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> ✓hick I may have, arising out of the performance of said contract,which are not set forth in said estimate. <br /> (,/p p_ � X Asst Secretary <br /> ;ONTRACTOR TITLE <br /> tinker Materials <br /> subscribed and sworn to before GARR1F O <br /> net S 8th da of September f owISSlpy 912 <br /> C 0---C7z4- Notary Public it/07- Ff� `� <br /> n and for the State of Washington,residing at Marysville p\Rr <br /> 8<I C <br /> V) 8.�8`2 <br /> <<` 008 <br /> vow " C)� <br /> PUBLIC WORKS DEPARTMENT/,� CER <br /> Certify the attached final APPROVED Date: /6/1_3_i_95--- <br /> :stimate to be based upon actual <br /> neasurements and to be true and correct. `D <br /> C - X "--=%119/ecr <br /> Construction Manager Utilities Director <br /> Tom Fuchs Tom Thetford <br /> INSTRUCTIONS <br /> ;fie Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> tgents and forwarded with the Final Contract Voucher Certification. <br /> 2ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim <br /> tttached. <br /> evised 9/94 <br /> 16 <br />