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I <br /> VSCertification of Compliance with <br /> IWage Payment Statutes <br /> EVERETT <br /> IWASHINGTON <br /> IThe bidder hereby certifies that, within the three-year period immediately preceding the bid <br /> solicitation date April 13, 2021, the bidder is not a "willful" violator, as defined in RCW 49.48.082, of <br /> Iany provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation <br /> and notice of assessment issued by the Department of Labor and Industries or through a civil judgment <br /> entered by a court of limited or general jurisdiction. <br /> II certify under penalty of perjury under the laws of the State of Washington that the foregoing is true <br /> and correct. <br /> ILOfk'es/de 1465 f ni'e5, T c . <br /> Bidder's Business Name <br /> 1 X �� <br /> g <br /> Si nature of Authorized Offici * <br /> I <br /> Ma 1-+6 (-paper <br /> Printed Name <br /> IP,,0•ec f nahoy e r <br /> Title <br /> I 1 <br /> 1-13 ` k2 ),1 /V7onrOa 17/1 <br /> Date City State <br /> 1 <br /> I <br /> Check One: <br /> Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation ig <br /> IState of Incorporation, or if not a corporation, State where business entity was formed: <br /> liVashr'ej 1 Qn <br /> IIf a co-partnership, give firm name under which business is transacted: <br /> I <br /> * <br /> If a corporation, proposal must be executed in the corporate name by the president or vice-president (or any <br /> I other corporate officer accompanied by evidence of authority to sign). If a co-partnership, proposal must be <br /> executed by a partner. <br /> I <br /> 2021 PAVEMENT MAINTENANCE OVERLAY PAGE 35 OF 35 DIVISION P <br /> IWORK ORDER 3751 MARCH 29, 2021 <br />