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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Tastad Construction, Inc. <br /> ADDRESS: 10615 180th Street SE <br /> CITY: Snohomish STATE: WA 98296 DATE: April 4, 2007 <br /> PROJECT TITLE: Garfield Park Playground and Perimeter Improvements PROJECT NO.: PK1006 <br /> DATE WORK COMPLETED: March 30, 2007 FINAL CONTRACT AMOUNT: $507,158.44 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached statement 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 from <br /> any employee of the City; I further certify that the attached final statement is a true and correct statement showing all <br /> the moneys due me from the City of,Everett under this contract; that I have carefully examined said final statement <br /> and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which II may have, arising out of the performance of said contract, which are not set forth in said statement. <br /> X k) �`U X Az-k.s r o <br /> CONTRACTOR TITLE <br /> Subscribed and sworn to before p.Nr),t. LAD,L 'uF�/// <br /> me his1-141day of I • otr , yc4A <br /> X L/ a-Y Notary Public <br /> -40 <br /> in <br /> , <br /> in and for the State of Washington, residing �' - <br /> at 036-2Ct Al A"— k gk°7p1-• <br /> -•Z� <br /> l <br /> PARKS AND RECREATION'�'t'MENT CERTIFICATION <br /> APPROVED Date: <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X X <br /> P ject Manager Director of Parks and Recreation <br /> Jonna Court Paul Kaftanski <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance By: X <br /> MAYOR <br /> Ray Stephanson <br /> Approved as to Form <br /> X <br /> City Attorney <br /> INSTRUCTIONS 1 r' <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with <br /> 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 attached. <br /> Revised 11-03 <br />