2010/01/20 Council Agenda Packet

• CITY OF EVERETT 5 FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Travers Electric ADDRESS: 122 Sturdevant Road CITY: Chehalis STATE: WA 98532 DATE: December 18,2009 PROJECT TITLE: Signal Improvements: Broadway&Everett AveWORK ORDER NO. 3244 DATE WORK COMPLETE: September 2,2009 FINAL AMOUNT: $665,631.42 CONTRACTOR'S CERTIFICATION I,the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may ave, arising out of the performance of said contract, which are not set forth in said estimate. X e 1 X Pre..,,S 1(L€ CONT CTOR TITLE I Notary Public TST,Inc. dba Travers Electric , • State of Washington MARGE A MOEN Subscribed and sworn to before I My Appointment'Expires Oct 26,zoto m t is H4-`--da. • - ab t o �Q�n ' Notary Public in and`fort►�- t.te . Washington, residing at 0i PS '7 � PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. X X III/4 (((f(iD Construction Manager Public Works : rector Tom Fuchs Dave Davis INSTRUCTIONS The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors, and all subcontractor's agents and forwarded with the Final Contract Voucher Certification. Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 9/94 11