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4 <br /> CITY OF EVERETT <br /> 3 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:Clements Bros, Inc. <br /> ADDRESS: P.O. Box 7964 <br /> CITY: Bonney Lake STATE: WA DATE: 08/22/08 <br /> PROJECT TITLE: Wiggums Hollow Skate Park PROJECT NO. 354 5000000023 650 <br /> DATE WORK COMPLETED: 08/15/08 FINAL CONTRACT AMOUNT: $564,451.76 (tax included) <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 ve, arising out of the performance of said contract, which are not set forth in said statement.p <br /> —,-,--e--,--f ___ X ...S.t,L,/ -6». ri,,,„,_,___,,,J_ (32-4-4 -li"\--(---' <br /> CONTRACTOR TITLE <br /> Subscribed and sworn to b-fo e 4 Notary.kk,bltc ; <br /> 4,- State of Washington <br /> m his day of CHRtST1NE M MISCHEL <br /> X istary Public My Appointr fei t Expires Nov 22, 2008 <br /> in and forte State of Washington, residing <br /> at Hon co, . <br /> PARKS AND RECREATION DEPARTMENT CERTIFICATION <br /> APPROVED Date: 5 - 29 - 08 <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge.eX • A J � x gatte4,AL <br /> Project M.1;ger Director of Parks and 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 <br /> 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 attached. <br /> bs-0 Revised 11-03 <br />