2017/04/19 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION DATE: November 10,2016 ADDRESS: PO Box 158 CONTRACTOR: KLB Construction CITY/STATE: Mukilteo WA 98275 PROJECT TITLE: E. Grand Ave Sewer Replacement WORK ORDER NO. UP 3398 &Storm Water Separation FINAL AMOUNT: $6,145,421.06 DATE WORK COMPLETE: April 22,2016 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 na .,.e which I may have, arising out of the performance of said contract, which are not set forth in said e I ate. X it oi '�� ' X Prmrid- CO T' ° T TITLE KLB Construction,Inc. 2' s � , Subscribed an to before me this day of 201 WAS 114 '� ♦� •.. • • ��s X Notary Public 0 - • in and for the State of Washington,residing at - Vijr+ 4 `� - •• , .•,fii•aL! . PUBLIC WORKS DEPARTMENT CERTIFICATION I Certify the attached final estimate to be based upon actual measurements and to be true and correct. APPROVED Date: / o A a"€7.d.4„.....- X Construction Manager Public Wogs6I' 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. 32