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3 CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:Pacific Crest Construction ADDRESS: 13619 Mukilteo Speedway, #5 <br /> CITY: Lynnwoodt STATE: WA 98087 DATE: September 24, 2008 <br /> PROJECT TITLE: Hypochlorite Facility WORK ORDER NO. UP3193 <br /> DATE WORK COMPLETE: September 23, 2008 FINAL AMOUNT: $ 4,339,670.01 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> 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 estimate is a true and correct statement showing all the <br /> monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> understand the s e and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I ' h. -, ari ing out of the performance of said contract, which are not set forth in said estimate. <br /> X �(� ` Aid& X F(?. 6-A-3 i <br /> CO -TRACTOR TITLE <br /> Pacific C..`` QJ <br /> f.Ogon <br /> Pi <Q4SSONF ' <br /> S •scri.-d tsworrt tielore <br /> m- thi dr • La's' :r, '— Zc7 <br /> X :/• , Klaus RAF; ; ary Public <br /> in andf;-04.,5tate o \V g 'n, residing at Eom oik.soc Gs-)A-6 bt,NG-ro r`S . <br /> 4'0 <br /> 011111110 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: <br /> /CD-1q- <br /> estimate to be based upon actual <br /> measurements and to be true and correct. o <br /> X -7,P7/ <br /> X '7 <br /> Construction Manager Utilities Director <br /> Tom Fuchs Tom Thetford <br /> INSTRUCTIONS <br /> The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's <br /> agents and forwarded with 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 <br /> attached. <br /> Revised 9/94 <br /> I- <br />