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CITY OF EVERETT <br /> 3 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Glacier Construction Services, Inc. ADDRESS: 12521 Evergreen Dr#A <br /> CITY: Mukilteo STATE: WA 98275 DATE: October 14, 2005 <br /> PROJECT TITLE: Perimeter Landfill Gas Collection WORK ORDER NO. UP2952 <br /> DATE WORK COMPLETE: September 30, 2005 FINAL AMOUNT: $ 1,028,563.67 <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 I may have, arising out of the performance of said contract, which are not set forth iniS ct.R imate. <br /> X -4/7 X z4 A r <br /> ssa Z/"1''� <br /> CONT C OR TITLE 9'NOT �F -� <br /> Glacier Construction Services,Inc. Q,,.49i- 53: <br /> Z <br /> 011 <br /> Subscribed and sworn to be ore <br /> �eUc <br /> me this 1% dayof c-0 6R V 2..O :; ' <br /> • <br /> X • e/ Notary Public ,�40i4h'ASHMG <br /> in and fors e State of Washington, residing at Eabv\MJ , WP - `"Y`--r'grGi 9. Zizn,Rhh <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: /121`76— <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X <br /> Construction Manager Utilities Director <br /> Tom 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 /> 5 <br />