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City of Everett 00 4113 - 5 <br /> 2021 Biosolids and Backwash Solids Removal UT 3752-1 / 20 <br /> 1.8 INTERESTED PARTIES <br /> A. The full names and residences of all persons and parties interested in this Bid as <br /> principals are as follows: <br /> NAME TITLE ADDRESS <br /> 1 .9 BID FORM SIGNATURES <br /> A. By submitting this Bid, Bidder certifies that it has reviewed the insurance <br /> requirements of Document 00 7200 — GENERAL CONDITIONS and certifies that <br /> coverage will be provided as required. <br /> The undersigned Bidder also hereby certifies that, within the three-year <br /> period immediately preceding the bid solicitation date for this Project, the <br /> bidder has not been determined by a final and binding citation and notice <br /> of assessment issued by the department of labor and industries or through <br /> a civil judgment entered by a court of limited or general jurisdiction to have <br /> willfully violated, as defined in RCW 49.48.082, any provision of chapter <br /> 49.46, 49.48, or 49.52 RCW. I certify (or declare) under penalty of perjury <br /> under the laws of the State of Washington that the foregoing sentence is <br /> true and correct. <br /> Signed this day of , 2020 <br /> Name of Bidder: <br /> Signature of Bidder's Authorized Agent: <br /> Title: <br /> Phone: <br /> State of Incorporation Contractor's License No. <br /> 00 4113 - 5 BID FORM <br />