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CITY OF EVERETT <br /> C FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:Hoffman Construction Company of Washington ADDRESS: 1505 Westlake Ave N, Suite 500 <br /> CITY: Seattle STATE: WA 98201 DATE: Aug. 27, 2007 <br /> PROJECT TITLE: WPCF Expansion Phase A WORK ORDER NO. UP-2993-40 <br /> DATE WORK COMPLETE: June 15, 2007 FINAL AMOUNT: $ 34,641,652.40 <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 in said estimate. <br /> CONTRACTOR TITLE <br /> Hoffman Construction Co. of WA K€LLIE N. JACKSON <br /> NOTARY PUBLIC <br /> Subscribed and sworn to before <br /> STATE OF WASHINGTON <br /> me this 21 day of A-vouSt , COMMISSION EXPIRES <br /> �� NOVEMBER 2,2010 <br /> X �hi- (N - otary Public �f <br /> in and for the St of ashington, residing at [TT/UL COj11 ITUlit11Sn nvizil <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: 012--r01 <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X / %� `�/ <br /> / X <br /> "' A/4-41 <br /> Contract 'anag: Utilities Director <br /> Timothy arks 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 /> 16 <br />