2012/09/12 Council Agenda Packet

• CITY OF EVERETT 6 FINAL CONTRACT VOUCHER CERTIFICATION DATE: August 20, 2012 ADDRESS: PO Box 481 CONTRACTOR: SRV Construction, Inc. CITY/STATE: Oak Harbor WA 98277 PROJECT TITLE: Water Trans. Line#4 Cathodic Protection WORK ORDER NO. UP 3432 DATE WORK COMPLETE: July 9, 2012. FINAL AMOUNT: $ 1,076,046.85 Exclusive of 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 understand the same and that I hereby release the City of Everett from any and all claims of what-sever nature whic I may have, arising out of the performance of said contract, which are not set forth in said e,timate. A VAIN X X C CON ' - CTO TITLE SRV Co sucti , Inc. Subscribes . . sw..-n to b‘;eine o1 day of �111i1�A - . , 2012 X ` t - •_$ •.;''' a�' "' i .,ton, residing at C �� .n I � :WASHY kill! EATH • ' it :' t.�. ent'Expires O tt•1r';q'' PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final estimate to be based upon actual measurements and to a 4 12 be true and correct. APPROVED Date AIM X Q:9?7,--,/7.:ibCL- X a ALA AL Construction Manager Public W.�'s 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 6/2012 58