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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: 1-10-2019 ADDRESS: PO Box 1348 <br /> CONTRACTOR: Trinity Contractors, Inc 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 /> Exclusive of State Sales Tax <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 <br /> that I am authorized to sign for the claimant; that I have not rented or purchased any equipment or materials <br /> from any employee of the City; I further certify that the attached fmal 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 carefully examined said i <br /> final estimate and understand the same and that I hereby release the City of Everett from any and all claims of <br /> whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in <br /> said estimate. 1 <br /> JiPces5; `��,tta�t�r�o <br /> NT CT-OR TITLE .. 5;.,nossion•.,.`ss' 'f <br /> Trinity Contractors,Inc. S +,o•:9' 1. <br /> ^ • <br /> No N o <br /> Subscribed and sworn to before me this t 4 day of s'0.Yi ual ,2019: tat s <br /> Y <br /> N Pub• lic • Ma € <br /> X <br /> Notary Publ '_*._&o''::'!?oz • <br /> o�♦,• <br /> in and for the State of Washington, residing at �GIr u Cl WA �'et f��ashirg���`% <br /> i <br /> C6vnw►tsCO" sic t're.s 11 I-7 I aD. <br /> g <br /> @q <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to i <br /> be true and correct. APPRO EDD : (-30-2°9tg 1 <br /> X �r ,ex-ek X t <br /> Construction Manager u is Works Director <br /> Tom Fuchs Ryan Sass <br /> i <br /> 6 <br /> 4 <br /> i <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. 1 <br /> 1 <br /> Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim ! <br /> attached. <br /> 1 <br /> Revised 612012 <br /> I <br />