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CITY OF EVERETT <br /> 8 <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: ® Corstone Contractors, LLC. <br /> ADDRESS: 1910 Bickford Ave. <br /> CITY: ZSnohomish STATE: ® WA ZIP: 98290 DATE: 12/28/2010 <br /> - PROJECT: Carl Gipson Senior Center-Additions PROJECT NO: 08-1055 <br /> DATE WORK COMPLETE:9/1/2010 FINAL AMOUNT$1,103,494.27 <br /> (including WSST) <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the above final amount is a proper charge for work <br /> performed and material furnished to the City of Everett, that the same or any part thereof has not been paid, and <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from <br /> any employee of the City; I further certify that the above final amount is a true and correct statement showing all <br /> the monies due me from the City of Everett under this contract; that I have carefully examined said final amount <br /> and understand the same and that I hereby release the City of Everett from any and all claims of whatsoever <br /> nature which I ay ha , 'sii' -eut-ef4he-performance of said contract, which are not set forth in said final <br /> amount. , , / /4 <br /> i ji <br /> ke3- -&ed\ <br /> CONTRACTOR TITLE <br /> S ��cribed a d sw rn to befor- me this V' .-C s day ofIt tiki 201i. i 4 <br /> `—�h"'L - / <br /> ► stary Public in and for the Statet of Washington <br /> residing at /v-- ne►.t.<-e-)N:q' Ps ` <br /> PROPERTY MANAGEMENT DEPARTMENT CERTIFICATION <br /> I Certify the above final amount to be APPROVED Date: 2116 /201/ <br /> Based upon actual work performed and <br /> To be true and correct. <br /> Project' etik-L._ <br /> daa AAt-p ,-,—.. <br /> Manager, Rubes( Sanchez Facilities Director, Carlton Gipson <br /> 9 y <br /> ADMINISTRATION USE ONLY <br /> Date of Acceptance By: <br /> Mayor, Ray Stephanson <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 /> 50 <br />