2005/10/26 Council Agenda Packet

CITY OF EVERETT 2 FINAL CONTRACT VOUCHER CERTIFICATION 'ONTRACTOR: Shoreline Construction ADDRESS: 21326 87th Ave SE 'ITY: Woodinville STATE: WA 98072 DATE: October 7, 2005 ROJECT ITI'LE: Water Main Replacement "F' WORK ORDER NO. UP3185 )ATE WORK COMPLETE: April 29, 2005 FINAL AMOUNT: $ 1,013,480.64 CONTRACTOR'S CERTIFICATION the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed nd material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am uthorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any mployee of the City; I further certify that the attached final estimate is a true and correct statement showing all the lonies due me from the City of Everett under this contract; that I have carefully examined said final estimate and nderstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature ✓hich I may have, .�_�' o of the performance of said contract, which are not set forth in said estimate. _ - X ��s, r T 'I:r'j'j R TITLF Notiti►inii, 1. shoreline• onstru• on �•� o,•.. �.,S subscribed and sworn to,before •'�• ��r44 i Z net /2'- d. . �� e.c, s : >: ,oG _ ll C O Notary Put k.;, 6' C ' nd foi'the State of Washington, residi 'al! AISHItWAO PUBLIC WORKS DEPARTMENT CERTIFICATION Certify the attached final APPROVED Date: (CI 13`0ST stimate to be based upon actual measurements and to be true and correct. T gift,v1.44r.L X Construction Manager Utilities Director Tom Fuchs Tom Thetford INSTRUCTIONS he Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's gents and forwarded with the Final Contract Voucher Certification. '.ontractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim ttached. revised 9/94 4