American Process Group Inc 7/9/2019

ICity of Everett 00 6519 - 1 2019 Biosolids Removal UT3705-2 ISECTION 00 6519 -CERTIFICATE OF COMPLETION FORM CONTRACTOR: I ADDRESS: CITY: STATE: WA DATE:_ PROJECT TITLE: 2019 Biosolids Removal PROJECT NO. UT3705-2 I DATE WORK COMPLETED: FINAL CONTRACT AMOUNT: $ CONTRACTOR'S CERTIFICATION II, the undersigned, having first been duly sworn, certify that the attached statement 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 statement is a true and correct statement showing all the moneys due me from the ' City of Everett under this contract;that I have carefully examined said final statement 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 statement. Ix x CONTRACTOR TITLE I Subscribed and sworn to before me this day of X Notary Public in and for the State of Washington, residing I at . DEPARTMENT CERTIFICATION I APPROVED Date: Certify the attached final II statement to be true and correct to the best of my knowledge. X X IProject Manager Director ADMINISTRATION USE ONLY I Date of Acceptance By: X Cassie Franklin, Mayor IApproved as to Form I X City Attorney INSTRUCTIONS I 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. I Contractor's Claims, if any, must be included and the Contractor's Certification must be labeled indicating a claim attached. Revised 11-03 END OF SECTION 00 6519 I I 00 6519 - 1 CERTIFICATE OF COMPLETION FORM