2011/11/09 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION CONTRACTOR: KLB Construction ADDRESS: P.O. Box 158 CITY: Mukilteo STATE: WA 98275 DATE: October 13,2011 PROJECT TITLE: Riverfront Surcharge,Phase 3 WORK ORDER NO. UP 3163 DATE WORK COMPLETE: September 28,2011 FINAL AMOUNT: $2,720,525.70 excluding Washington State Sales Tax 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 tinders and the same and that I hereby release the City of Everett from any and all claims of whatsoever nature whi i may . ari,Rg out of the performance of said contract,which are not set forth in said estimate. x al0 CO T ' • 01 TITLE KLB C•nstruction • �,�tssroy G • o F G Na. 13Subscribed and sworn to be ore GARYz m' • 4 of pUgC/� Public 9•zj?ors in . i u or I e State of Washington, residing at ,,, ;C 1 U-l. 0 .c' ASH1N PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final APPROVED Date: estimate to be based upon actual measurements and to be true and correct. ,ti/vL X ��P."ar,/ ac X Construction Manager Public Works Director Tom Fuchs 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 16