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I <br /> City of Everett 00 4113 - 5 <br /> I <br /> 2021 Trickling Filter Media Replacement UP 3742-3 <br /> I <br /> I1.9 BID FORM SIGNATURES <br /> By submitting this Bid, Bidder certifies that it has reviewed the insurance <br /> IA. <br /> requirements of Document 00 7200—GENERAL CONDITIONS and certifies that <br /> coverage will be provided as required. <br /> IB. The undersigned Bidder also hereby certifies that, within the three-year period <br /> immediately preceding the bid solicitation date for this project, the Bidder has not <br /> I been determined by a final and binding citation and notice of assessment issued <br /> by the department of labor and industries or through a civil judgment entered by <br /> a court of limited or general jurisdiction to have willfully violated, as defined in <br /> 1 RCW 49.48.082, any provision of chapter 49.46, 49.48, or 49.52 RCW. The <br /> undersigned declares under penalty of perjury under the laws of the State of <br /> Washington that the foregoing sentence is true and correct. <br /> I <br /> 2021 <br /> Signed this 4th day of May ,.620 LM <br /> Name of Bidder: McClure and Sons, Inc. , i <br /> Signature of Bidder's Authorized Agent: ;- , v ' <br /> i <br /> ITitle: President <br /> Phone: (425) 316-6999 <br /> ICity and State Where Signed: Mill Creek WA <br /> I <br /> State of Incorporation Washington Contractor's License No. MCCLUSI101 MJ <br /> IWashington State MCCLUSI101 MJ <br /> IEmail address of Bidder's authorized Agent: <br /> les@mcclureandsons.com bids@mcclureandsons.com <br /> I <br /> The remainder of this page intentionally left blank <br /> I <br /> 00 4113 - 5 BID FORM <br /> 1 <br />