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CITY OF EVERETT <br /> 4 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Shoreline Construction ADDRESS: PO Box 358 <br /> CITY: Woodinville STATE: WA 98072 DATE: July 21, 2009 <br /> PROJECT TITLE: Sewer"K", Phase 1 WORK ORDER NO. UP3271 <br /> DATE WORK COMPLETE: May 18, 2009 FINAL AMOUNT: $ 4,276,069.21 <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 same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may hav . is• ! o t of the performance of said contract, which are not set forth in said estimate. <br /> A PS/elP,vt- <br /> C s ' `t ''TO$ TITLE ,c ����ii <br /> p.K. F iii <br /> horelii • Construction <Z`�4;tssioitigC'0.�� <br /> S. <br /> Subscribed and sworn to before �.. DEC "'L <br /> m- . is 221-- a - of a :*: 11 :*12 <br /> A(;r.__,,,, _ ,, ` Notary Public . s o <br /> n ane for the State of Washington, residingat <br /> g %,. W�� `�� <br /> 0 .... <br /> �i�gRY pOvv`�� <br /> illifitiO <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: ?-31 -61 <br /> — <br /> estimate to be based upon actual <br /> measurements' and to be true and correct. <br /> X� ..4,162- X <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 /> 12 <br />