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1 <br /> E <br /> 6 E <br /> CITY OF EVERETT ► <br /> FINAL CONTRACT VOUCHER CERTIFICATION i <br /> �10-2019 ADDRESS: PO Box 1348 <br /> CONTRACTOR: Trinity Contractors,Inc <br /> DATE: 1 CITY/STATE:Marysville,WA 98270 <br /> PROJECT TITLE: Citywide Intersection Signing Project WORK ORDER NO. PW 3628 <br /> DATE WORK COMPLETE: 2-09-18 FINAL AMOUNT: $ 670,455.36 <br /> 1 <br /> Exclusive of State Sales Tax <br /> t <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work <br /> performed and material furnished to the City of Everett,that the same or any part thereof has not been paid, and i <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials 1 <br /> from any employee of the City; I further certify that the attached final estimate is a true and correct statement <br /> showing all the monies due me from the City of Everett under this contract; that I have cullly examinced said <br /> final estimate.and understand the same and that I hereby release the City of Everett fromany <br /> and ims of i <br /> whatsoever nature which I may have, arising out of the performance of said contract,which are not set forth in I <br /> said estimate. ��a t o r��� <br /> / X______Preg.51 6,___QA/6- °°°�� 1 L a `1t, <br /> w� isslo ••. �i <br /> NT CT-OR TITLE �:Goon n 6..,s, ,.., <br /> Trinity Contractors,Inc. ' " 1 <br /> i • NtaNY r i <br /> ry o <br /> Subscribed and sworn to before me this s-I ` day of Y1 t G b�'ll� 2019..= i •acn: �Ubfi = € <br /> X®m u( L <br /> _9), 's0l. •o <br /> Notary Public ®� o ��°�� o ♦ 13 <br /> in and for the State of Washington,residing at �(Jl.�rt.‘511 G t I �. V.lr� ��`'.e a s irg�se°° <br /> �q/� tyy�1//��yy�� `' I� (gyp P� V'9111116?��4 = <br /> CIOW10/05 t0.. 5 CO e-Ac p 1 S ✓ r I\1 I a— <br /> 8 <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be € <br /> based upon actual measurements and to t <br /> be true and correct. . APPROVED D : l 3O fit? <br /> 4 - <br /> Construction Manager• Public Works Director <br /> Tom Fuchs Ryan Sass <br /> ii <br /> ii <br /> I <br /> E <br /> 1 <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 /> Revised 6121312 19 <br />