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• CITY <br /> CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION <br /> DATE: November 10, 2016 ADDRESS: PO Box 158 <br /> CONTRACTOR: KLB Construction CITY/STATE: Mukilteo WA 98275 <br /> PROJECT TITLE: E. Grand Ave Sewer Replacement WORK ORDER NO. UP 3398 <br /> & Storm Water Separation FINAL AMOUNT: $6,145,421.06 <br /> DATE WORK COMPLETE: April 22, 2016 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 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 carefully examined said <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 esti ate. <br /> X <br /> dILii1 x �s <br /> CO` ` •' T 1I I' TITLE <br /> KL d'onstru r ion, Inc. <br /> Subscribed worn to before me this 'Zi`64' day of Wbv 1/1 rte' , 20160 <br /> X <br /> 00, <br /> .,ASM �''•. <br /> Notary Public �.' 0 •••••.'`1rQ'•,,,, <br /> in and for the State of Washington, residing at al( iS1' 1W11- ?a .*O T 0 A�1► • <br /> N• <br /> =n:TINA MRO!Ey:«�`•= <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION ' /Op aseo! 1,,� <br /> I Certify the attached final estimate to be <br /> based upon actual measurements and to <br /> be true and correct. APPROVED Date: I I III <br /> X <br /> % dL i!tafir <br /> Construction Manager Public W e' r i "c er <br /> Tom Fuchs Dave D.vis <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 6/2012 <br />