2010/05/26 Council Agenda Packet

16 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR:Shoreline Construction ADDRESS: PO Box 358 CITY: Woodinville STATE: WA 98072 DATE: April 23, 2010 PROJECT TITLE: Bond Street Interceptor — CSO WORK ORDER NO. UP3407 DATE WORK COMPLETE: April 18, 2010 FINAL AMOUNT: $ 521,747.24 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 dame and that I hereby release the City of Everett from any and all claims of whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in said estimate. Xll_ t /.fie' X ._��i r CONTRACTOR TITLE Shoreline Construction Subscribed . • to bepVe • ..�� J PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. P X �.u,� X Construction Manager Public Works irector Tom Fuchs Dave Davis INSTRUCTIONS '.011 a 1411,%i p►AY4g; to E y�•. ZjQ $ NOTARY y pulwo i2 "r4. WAS��A �. 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 9/94 114