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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> 4 <br /> CONTRACTOR: Thomco Construction, Inc. ADDRESS: 13700 44t St. NE <br /> CITY: Lake Stevens STATE: WA 98258 DATE: December 18,2009 <br /> PROJECT TITLE: Broadway @ Beverly Blvd. Improvements WORK ORDER NO. 2966 <br /> DATE WORK COMPLETE: November 25, 2009 FINAL AMOUNT: $1,475,473.76 <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 have, arising out of the performance of said contract, which are not set forth in said estimate. <br /> x . ����..��G �.�..l.�D x Piwgi Mai-64,4 <br /> CONT 'ACTOR TITLE p,A. fid' <br /> Thomco Construction Inc. P�t ss N )1 <br /> Subscribed and sworn to before ; --;.( N S <br /> me th's (ZT�day of�AtvtaA�t 201 v �O <br /> X <br /> ��t R ilia) Notary Public ,�'�9 �• &30.13 4=; <br /> in and for the State of Washington,residing at iuf.. a ►'=rte '�, i <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X 57/7.44WL X b �' ik <br /> Construction Manager Public Works Director <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 /> 9 <br />