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CITY OF EVERETT <br /> 6 FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: McClure& Sons ADDRESS: 15714 Country Club Drive <br /> CITY: Mill Creek STATE: WA 98012 • DATE: June 22, 2011 <br /> PROJECT TITLE: WPCF Phase B-1A Improvements WORK ORDER NO.: UP 3358 <br /> DATE WORK COMPLETE; June 8, 2011 FINAL AMOT3 T: $ 385,939.00 <br /> excluding Washington State Sales Tax <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work perfouued <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 /> em. oyee • the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> mo 'es due e from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> u •;rstand . e same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> w is c' I m, t! arising . t of the performance of said contract, which are not set forth in said estimate. <br /> x President <br /> O CTO ' TITLE <br /> ��� d�•'�SIaNE•�9 ��i <br /> Mc ure and Son c. >�lQ•* <br /> i c). NOTARY <br /> Subscribed and sworn o before =- • PUBLIC <br /> me this • da of i►. ..Dl 1 •• Oz. <br /> X�:. L ,d Notary Public Sl•,•:%• °Sno�201,./ ?`�•` <br /> in . the State of Washington,residing at /'�il/ i`tek �� moi, OF• pg'Z�� ,` <br /> t/i�rr W <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: " 2 `` t( <br /> estimate to be based upon actual <br /> measurements and to be true and correct. / <br /> X ,1X <br /> /,/ify <br /> Construction Manager Public Works D' e or <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 /> • <br /> • <br /> 20 <br />