2007/10/24 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Road Construction Northwest, Inc. ADDRESS: PO Box 188 6 CITY: Renton STATE: WA 98057 DATE: April 23, 2007 PROJECT TITLE: Water Main Replacement "I" WORK ORDER NO. 3257 DATE WORK COMPLETE: April 13, 2007 FINAL AMOUNT: $ 577,497.75 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 whichmay have, ar.sing out of the performance of said contract, which are not set forth in said estimate. X X U� C TRA TITLE Road Construction Northwest Subscribed and sworn to before me this /o day of .�� Z � 0 .' o � m otary PublicaY in and for the State of Washington, residing at,4-A, 4A /jj oil%Idlit X`��+� PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: �'17 estimate to be based upon actual measurements and to be true and correct. X �"7- , X -,,��Azzo 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. 19