2007/07/11 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR:Mosbrucker Excavating ADDRESS: PO Box 745 CITY: Bothell STATE: WA 98041 DATE: June 19, 2007 PROJECT TITLE: 100`t' Street SW Pedestrian Improvements WORK ORDER NO. 3232 DATE WORK COMPLETE: June 6, 2007 FINAL AMOUNT: $ 107,504.91 CONTRACTOR'S CERTIFICATION I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature whiic�h I may have, arising out of the performance of said contract, which are not set forth in said estimate. X-0 l' k X CONTRACTOR TITLE Mosbrucker Excavating Subscribed and swor to before me thi �5a day of� X o, D , r� otary Public in and for the State of Washington, residing PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. X7z X Construction Manager Utilities Director Tom Fuchs Tom Thetford INSTRUCTIONS The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with the Final Contract Voucher Certification. Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 9/94