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I0. , <br /> ATTACHMENT I: CERTIFIED PROJECT COMPLETION REPORT <br /> PUBLIC WORKS BOARD <br /> • DRINKING WATER STATE REVOLVING FUND <br /> Loan Number: DM07-952-041 Contractor:City of Everett <br /> Project Name: Design&Const. Of 2nd 5-Million Gallon Address: 3200 Cedar Street <br /> Clearwell <br /> Original or Extended Project completion Date: 8/6/2011 Everett, WA 98201 <br /> Chief Executive Officer Certff ca ion --- <br /> The Chief Executive Officer of the Co]itra t� �iwer to es•that.{'.—"7-44t,. <br /> -.6- 4,,,,,. . <br /> �' ..,..7,:::.4,i,1%,.:;:.,..-..,,,. k. i <br /> • To the best of his/her,de. ' 1 4'-c,the financial inforation and data pr ded inijs,report is true and correct as of <br /> c� <br /> the signature date n.'dicate d below,aad-no roject costs listed in this report incurred` ore the Environmental <br /> Protection Age oy( .4)grantttiawa�rd;p,flab.or after the date of the:project c etion; '.:__; <br /> • Records sup rtii, the• t ormat on prht ded ul this report are on file and'Will be;ipFade available by the <br /> ContractorfBorrovi r tzpoit.request <br /> • There are!no out!tandn liens against this project.-and <br /> • Attached is either a copy of'the project's Construction Completion Repoirt(s)submitted to`Washington State <br /> Departinefif Of Health fpr; eiir approval; OR,a copy of the letter from the Washington State Department of Health <br /> acknowledging receipt and approvalof the project's Construction.Completion Report(s), ,WAC 246=290-120(5), <br /> • • <br /> 246-290-125(2)(b)or WAC'246-290-125(3). <br /> • <br /> Signature of Chief Executive.Officer Title <br /> Print Name. Date of Signature - <br /> Certified .Public Accountant.Certification — for Non-Municipal Jurisdictions <br /> The Certified Public Accountant of the Contractor/Borrower certifies that: <br /> • Records supporting the financial information provided in Sections 1 and 2 have been reviewed in accordance with <br /> standards established,by the American Institute.of Certified Public Accountants; <br /> • Records were found consistent and in compliance with the Drinking Water State Revolving Fund Loan <br /> Contract/Agreeinent's Scope.of Work and the Washington Administrative:Code(WAC)399-30-030(3)which <br /> identifies eligible Costs for projects assisted with a DWSRF loan. <br /> Signature of Certified Public Accountant Date of Signature <br /> Print Name Phone Fax • <br /> Address <br /> 112 <br /> City of Everett Page 3 Attachment I:Certified Project Completion Report <br /> DM07-952-041 11/9/2010 Drinking Water State Revolving Fund <br />