2007/11/14 Council Agenda Packet

CITY OF EVEREI I FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Stripe Rite, Inc. ADDRESS: PO Box 1724 3 CITY: Auburn STATE: WA 98071 DATE: August 17, 2007 PROJECT TITLE: 2007 Pavement Marking WORK ORDER NO. 3290 DATE WORK COMPLETE: July 27, 2007 FINAL AMOUNT: $ 52,739.00 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 which I ma have, arisin out of the performance of said contract, which are not set forth in said estimate. ys oANi� 14, `C-ONTA TOR TITL O 0S'o7 = _- M+y; � //i Stripe Rite, Inc. _ , a , �o `� ; • %gym a z; Subscribed and swornto bef re N O ��a_0 me is Z S day of S-t? V'I • y�y 4` slg�' X ��l lk�e iJV\ tary Public CION t.11 in and for the State of Washington, residing at (Qt • Z�,1ftyX ��G . • PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: G 11-2 (-1 estimate to be based upon actual. measurements and to be true and correct. X 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 6