Laserfiche WebLink
CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> 2 <br /> CONTRACTOR:Razz Construction, Inc. <br /> ADDRESS: 4055 Hammer Drive <br /> CITY: Bellingham STATE: WA DATE: <br /> PROJECT TITLE: Forest Park S ray Pool PROJECT NO. 354 5000000033 650 <br /> DATE WORK COMPLETED:A Spray <br /> 01 FINAL CONTRACT AMOUNT: $389,055.43 <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 that <br /> I am 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 statement is a true and correct statement showing all the <br /> moneys due me from the City of Everett under this contract; that I have carefully examined said final statement and <br /> understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which <br /> I may have, arising out of the perfo ance of said contract, which are not set forth in said statement. <br /> )C D_,-,-✓c Q A X ?f U Sk va f \1�1��11 <br /> CONTRACTOR TITLE <br /> �.��«N•J•.0o �',i <br /> Subscribed and sworn to before ���VOr•'a�sS1O"'i,'••Q <br /> • <br /> me thisZ is of .FC w,b-e_V r�OTAf),,,� % <br /> X �QM Notary Public ••►•.• <br /> in and for the e of Washington, residing kw* ' <br /> at 1?),-6 i\lhCi hoA--L . � &" 0 z <br /> id, • <br /> o, ��``` <br /> PARKS AND RECREATION DEPARTMENT CERTIFICATION <br /> APPROVED Date: OC--T 4, 2.C t7 <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X /J X 1 jaw l - ; , <br /> Project Ma9 er Director of Park nd Recreation <br /> Henry Schroder 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 <br /> The Affidavit of Wages Paid must be prepared by the prime contractor,all subcontractors, and all subcontractor's agents and forwarded with the <br /> 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 />