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CITY OF EVERETT <br /> 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 ave, arising out of the performance of said contract, which are not set forth in said statement.Q <br /> X _Clayr - X C . 11S1 `l a ,i1i <br /> CONTRACTOR TITLE <br /> Subscribed and sw n to b fore Notary Public <br /> mei is day of 1 State of V4obshington <br /> X f i Notary Public I CHRISTINE M MISCHEL <br /> in and or the tate of Washington, residing ' My Appointment Expires Nov 22, 2008 <br /> at �,Q,VD • <br /> PARKS AND RECREATION DEPARTMENT CERTIFICATION <br /> APPROVED Date: e - Z et -Oa <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. <br /> X 1 Xg4e-ile04t.414? <br /> Project Mana r 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 /> Revised 11-03 <br /> 13 <br />