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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:Marshbank Construction ADDRESS: PO Box 97 0 <br /> J <br /> CITY: Lake Stevens STATE: WA 98258 DATE: June 18, 2007 <br /> PROJECT TITLE: Sewer System Replacement"H" WORK ORDER NO. UP 3206 <br /> DATE WORK COMPLETE: May 22, 2007 FINAL AMOUNT: $ 1,687,722.75 <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 sam- a .11 ,10 :reby release the City of Everett from any and all claims of whatsoever nature <br /> which I m. -. �i jrlout o e performance of said contract, which are not set forth in said estimate. <br /> X / X Vi���i7�p��.r Pk' Sq ' <br /> C I `T' , I TITLE = � ,, ��, <br /> Az.. 4 g5�� 414,4� ', <br /> Marshban ' instruction = -.4� lAit A ►a%, <br /> Subscribed and sworn to before -- 5s� ,, 4, o <br /> me(i s da of '\�2 1 `� 411' tis ' N <br /> X '" 'fir. c Y Notary Public r #�i 1 ''t114 %%% .��.�%%+,- <br /> in and for the State o ashington, residing at S`(\AV\T)Yr\- CQvYN?c��, O�010,43 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: 2-3-07 <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X � x ,_2(„71-17-0, <br /> Construction Manager Utilities Director <br /> Torn 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 /> 8 <br />