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6 CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> CONTRACTOR: Shoreline Construction ADDRESS: PO Box 358 <br /> CITY: Woodinville WA 98072 DATE: April 26, 2012 <br /> PROJECT TITLE: Sewer Sys. L Replacement&Improvements WORK ORDER NO. UP3398A <br /> DATE WORK COMPLETE: November 22, 2011 FINAL AMOUNT: $3,356,592.51 <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <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 /> employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> monies due me from the City of Everett under this contract; that I have carefully examined said final estimate and <br /> understand the same and that I hereby release the City of Everett from any and all claims of whatsoever nature <br /> which I may ha g o t of the performance of said contract,which are not set forth in said estimate. <br /> X /� _ �/ XTas <br /> tt• rve.,esT— <br /> C I '' 'moi irrifTITLE ottsilittio <br /> Shoref'Shoref viCo luction ���•��aAYE,y�'i,�y <br /> �4i �b�tOM fir-,sD <br /> Subscribed and sworn to before `�. . OM <br /> me <br /> me this 3Rcl da of M- _ apt a NO1 Y <br /> �„ P... �; Notary Public ;,^_ ,_ ++�__ ,, MUG <br /> in a d or t 1. tate ► Washington, residing at D Doorb))16-1 1�55h( IU�J • ,,V4,..14.1104 <br /> ‘foit oi°P 044 <br /> t�ut1 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X , csa;6.-- X • <br /> Construction Manager Public Works Director <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 /> Revised 9/94 <br /> 30 <br />