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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> 4 <br /> CONTRACTOR:Cemex Construction Materials ADDRESS: PO Box 2037 <br /> CITY: Everett STATE: WA 98213 DATE: October 28, 2009 <br /> PROJECT TITLE: 2009 Hot Mix Asphalt Overlay WORK ORDER NO_334 <br /> DATE WORK COMPLETE: September 5, 2009 FINAL AMOUNT: $1,151,956.48 <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 /> underst. • the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> whic• „y -, .rising ou +f the performance of said contract, which are not set forth in said estimate. <br /> 0X / i _ALA., X Manager <br /> CONTRACT 1 R " TITLE <br /> Cemex Construction Materials Pacific LLC <br /> .� og24 IE p' <br /> Subscribed and sworn to before r G4MISSION��L, <br /> me=4thg=.,..,f November, 2009 �o �A/ cf�X Notary Public i `CTARy t <br /> in and for the State of Washington, residing at Marysville fp' "il�tiC <br /> \7:,)), 28- 012 0� <br /> C <br /> t iA5H\NG <br /> PUBLIC WORKS DEPARTMENT CET4FI€ATION <br /> I Certify the attached final APPROVED Date: /,,-)---2 -U9 <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> / . <br /> X Xi, /.` , _ _ <br /> ..... <br /> Construction Manager Public Works o irevor <br /> Tom Fuchs Dave Davis <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 /> 11 <br />