2011/09/14 Council Agenda Packet

3 CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: Stripe Rite, Inc. ADDRESS: 1813 137th Ave. E. CITY: Sumner STATE: WA 98390 DATE: August 23, 2011 PROJECT TITLE: Pavement Marking 2011 WORK ORDER NO. PW 3448 DATE WORK COMPLETE: July 18, 2011 FINAL AMOUNT: $ 103,154.60 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 same and that I hereby release the City of Everett from any and all claims of whatsoever nature whic I may have, arising out of the performance of said contract, which are,, ll not set forth in said estimate. X a.( !1►L A k J x ft )th riha,�.c� J ' \+"i.,Ni". C 11� TOR TITLE a 46114:tfixtt. J Stripe Rite, Inc. vt %., Sub cribed and sworn to before If v. ` .. m is ' j,y of "t i (..(..-v-- Notary Public pl';,"1.. � _"V f in and for/the State of Washington, residingat • '' � ' ,. g �. . PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual r-a .rements d to be t e and correct. 41,4// X ,,ii ..li /I / i f(.tructio ('anage/ Public Works Director T Fuchsof // Dave Davis INSTRUCTIONS 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