2013/02/20 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION DATE: January 8, 2013 ADDRESS: PO Box 158 CONTRACTOR: KLB Construction CITY/STATE: Mukilteo WA 98275 PROJECT TITLE: WMVD Pedestrian&Bicycle Safety WORK ORDER NO. PW 3268 DATE WORK COMPLETE: November 11, 2011 FINAL AMOUNT: $ 689,176.90 (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 whatsoever nae which I may have, arising out of the performance of said contract, which are not set forth in said =st i te. I . X itl'i all" If x (-e-si t COw ,.ell I R TITLE KL onstruction - �� q Subscribed and sworn to beffore me this day of�.G� \UCLif ) , 2013 0°NOTAR �°�P� Z �,� i;AL -- ( -4 LIC N otary Public .% 9'27-?0130' I in and for the State of Washington,residing at Q_ 'A Jl-i\'' PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final estimate to be ,24 1_ based upon actual measurements and to be true and correct. APPROVED Date:. X ci. ,. :�.�fu� x f/A ' i Construction Manager Public Works"'L rec t P t 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 22