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CITY OF EVERETT <br /> FINAL CONTRACT VOUCHER CERTIFICATION CITY <br /> CONTRACTOR: T Bailey, Inc. ADDRESS: 12441 Barthlomew Rd <br /> CITY: Anacortes STATE: WA 98221 DATE: October 11, 2018 <br /> PROJECT TITLE: WFP East Clearwell Roof Replacement Project <br /> WORK ORDER NO. UP 3662 <br /> DATE WORK COMPLETE: September 25, 2018 FINAL AMOUNT: $3,116,022.97 (includes WSST) <br /> CONTRACTOR'S CERTIFICATION <br /> I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed <br /> and material furnished to the City of Everett, that the same or any part thereof has not been paid, and that I am <br /> authorized to sign for the claimant; that I have not rented or purchased any equipment or materials from any <br /> employee of the City; I further certify that the attached final estimate is a true and correct statement showing all the <br /> monies due me from the City of - ett under this contract; that I have carefully examined said final estimate and <br /> understand the s. • and release the City of Everett from any and all claims of whatsoever nature <br /> which I maarising s . _;. the performance of said contract, which are not set forth in said estimate. <br /> X <br /> eie <br /> T ' - - i = ITLE <br /> T Bailey, Inc. `\>'._,e.A <br /> �O? .�ssioNF•.0�� <br /> Subscribed and sworn to before •••• <br /> �:o�" �A:•�_ <br /> me tl day of / _ • NO7;4R- 9N:z <br /> XI)/A, •(,�` flid'G�- 'Notary Public = ''oauc <br /> in land fo he State of Washington, residing at t (tt k 'is sI < < � %��`9ti� � O?' <br /> , io <br /> 1SN% \\. <br /> PUBLIC WORKS DEPARTMENT CERTIFICATION <br /> I Certify the attached final APPROVED Date: l//2-4 <br /> estimate to be based upon actual <br /> measurements and to be true and correct. <br /> X -,ViAjZzel_.. X <br /> d�tl <br /> exiaL <br /> Construction Manager /' <br /> i n Utilities Direcfbr <br /> Tom Fuchs Paul Kaftanski <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 9/94 <br />