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p, CITY OF EVERETT <br /> .► FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:McClure & Sons, Inc. ADDRESS: 15714 Country Club Drive <br /> CITY: Mill Creek STATE: WA 98012 DATE: March 16, 2009 <br /> PROJECT TITLE: WPCF Effluent Flow Splitter WORK ORDER NO. 2933 <br /> DATE WORK COMPLETE: March 13, 2009 FINAL AMOUNT: $ 366,822.56 <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 /> un• rstand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> w i'h I ma have, arising out of the performance of said contract, which are not set forth in said estimate. <br /> t�iiitisiiii <br /> X - ♦ X */'9l�0,d ..4.4,44GFes 't" <br /> CO TRACTOR TITLE <br /> Mc I lure & Sons, Inc. �••o�� slum '4. <br /> Subscribed and sworn to before U NOTARY <br /> PUBLIC <br /> me this /SS day of ` 2OO �v�►: •�,`O <br /> X or � 7 7L ���� Notary Public ';9>�•-os, <br /> -• <br /> in dthe State of Washington, residing at 1-47/ (,yefc' (off '!•,�or.WAS' <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> -01 <br /> I Certify the attached final APPROVED Date: 3-2-3 <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X X larl) <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 />