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FORM 4.02 SUPPLIER COMMITMENT AND INFORMATION <br />REQUEST FOR PROPOSAL #2021-020 ROCK CRUSHER WITH TRADE-IN OPTION <br />Company <br />Powerscreen <br />Name: <br />of <br />Washington, <br />Inc. <br />Company <br />7915 <br />S <br />261st <br />Address: <br />St <br />City: <br />Kent <br />State: <br />WA <br />ZIP: <br />98032 <br />Tax <br />91-1707425 <br />ID <br />#: <br />1 <br />U <br />B <br />I#: <br />601-674-531 <br />Legal <br />C- <br />Corporation <br />status <br />of <br />supplier <br />organization, <br />i.e., corporation, <br />partnership, <br />sole <br />proprietorship. <br />Website: <br />www.powerscreen-wa.com <br />City <br />Pending <br />of <br />Everett <br />— <br />Application <br />Business <br />License# <br />already <br />submitted <br />Supplier <br />Patrick <br />Contact <br />Lowe <br />Name <br />(if <br />different <br />from <br />Authorizing <br />Official): <br />Supplier <br />President <br />Contact <br />Title <br />Supplier <br />Pat&i <br />Powerscreen-wa.com <br />Contact <br />Email <br />: <br />Supplier <br />(253) <br />209-2900 <br />Contact <br />Direct <br />Phone: <br />Supplier <br />Contact <br />Address <br />(if <br />different <br />from <br />above): <br />City: <br />Stat <br />e: <br />ZIP: <br />By responding to this solicitation, the Supplier understands and agrees to be bound by all requirements and contract <br />terms and conditions contained in this solicitation. By signing this form, the Supplier acknowledges receipt and <br />understanding of any and all addenda issued for this solicitation. This form, signed by an individual authorized to legally <br />commit the Supplier, must be submitted as the cover page. <br />The Supplier also certifies that: <br />• I am authorized to commit my firm to this Proposal and that the information herein is valid for 90 days from this date. <br />• That all information presented herein is accurate and complete and that the scope of work can be performed as presented in <br />this proposal upon the City's request. <br />• That I have had an opportunity to ask questions regarding this Proposal and that those questions have been answered. <br />• That this Proposal response is made without prior understanding, agreement, or connection with any corporation, firm, or <br />person submitting an offer for this Proposal and is in all respects fair and without collusion or fraud. <br />Authorizing Official Name: <br />Patrick Lowe <br />Authorizing Official Email: <br />patApowerscreen-wa com <br />Authorizing Official Title: <br />President <br />Authorizing Official Phone: <br />(253) 209-2900 <br />Authorizing OfficiI Signa ire* and Date: June 28,2021 <br />*A signat ( rn, s an by nal signature :'a"copy of an original signature . a PDF scan of an original signature . or a DocuSign/AdobeSign electronic <br />signature (° V.Y7�-` <br />Page 13 of 22 <br />