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CITY OF EVERETT 3 <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR:Faber Brothers Construction <br /> ADDRESS: 131 East Grover <br /> CITY: Lynden STATE: WA DATE:Jr) - 1 - 6 <br /> PROJECT TITLE: Lions Park Renovation PROJECT NO. <br /> DATE WORK COMPLETED: &-)4-Og FINAL CONTRACT AMOUNT: $-7Ss 064 .36 1- s <br /> • CONTRACTOR'S CERTIFICATION <br /> • <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 d - e from the City of Everett under this contract; that I have carefully examined said final statement and <br /> underst. d t• e same and that I hereby release the City of Everett.from any and all claims of whatsoever nature which <br /> I may .ve ;risi G out of the performance of said contract,Which are not set forth in said statement. <br /> X i eM /1/ )/ X ``�tt��u a urrrr� <br /> O TRACTOR TITL .‘ N ..... <br /> Subscribed and sworn to before v. r': <br /> NOTARY <br /> me Ns/55 day of ��z/ G <br /> WO <br /> Notary Public = _ 170 <br /> in and fsrkthe State of Washington, residingpUBO' I <br /> 113 <br /> at "."-•*ti <br /> PARKS AND RECREATION DEPARTMENT CERTIFICATION <br /> APPROVED Date: <br /> I Certify the attached final <br /> statement to be true and correct <br /> to the best of my knowledge. / <br /> x <br /> 'roject Man.•er Director of Pa s and�ecreation <br /> Your Name Here 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,andall 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 /> • 7 ,... <br />