2015/12/30 Council Agenda Packet

CITY OF EVERETT FINAL CONTRACT VOUCHER CERTIFICATION DATE: November 5,2013 ADDRESS: 4309 W. 27th Place,Suite 103 CONTRACTOR: Tellus,LLC CITY/STATE: Kennewick WA 98338 PROJECT TITLE: Snoh.River Outfall(SRO)7 Replacement WORK ORDER NO. UP 3506 DATE WORK COMPLETE: September 19, 2013 FINAL AMOUNT: $75,509.79 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 nature which I may have, arising out of the performance of said contract, which are not set forth in said estimate. • X J,- X CONTRACTOR ^-" TITLE ��jeiteeeere Talus, r i Tus,LLC ` PE ,,,,,,,,,,�q Subscribed and sworn to before me this df.) day of ON- 02c � ,2011+ ;�� -jp,RY h1e y Public r p 2 ` in and for the State of Washington,residing at lAtAs *, "" 10',,°`� PUBLIC WORKS DEPARTMENT CERTINCATION I Certify the attached final estimate to be based upon actual measurements.and to I be true and correct. APPROVED ►at:: , X ,r M_LAE 1 Construction Manager Public Works Dire-Ctbr 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%.012 44