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This form must be submitted with the Bid Proposal or as a <br /> I In Supplement to the Bid no later than 24 hours after the time for <br /> EVE R E T T delivery of the Bid Proposal, as provided for in Section 1-02.9 of <br /> I <br /> WASHINGTON the Contract Provisions. <br /> Certification of Compliance with Wage Payment Statutes <br /> The bidder hereby certifies that, within the three-year period immediately preceding the bid <br /> Isolicitation date March 15, 2022, the bidder is not a "willful" violator, as defined in RCW 49.48.082, <br /> of any 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 /> Ientered by a court of limited or general jurisdiction. <br /> I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true <br /> ' and correct. <br /> Central Paving, LLC <br /> Bidder's Business Name <br /> /k <br /> Signs 'ure Auth rued icial* <br /> Bryce Harem <br /> IPrinted Name <br /> Construction Manager <br /> I Title <br /> 03/15/2022 Ellensburg WA <br /> IDate City where signed State <br /> ICheck One: <br /> Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation IN <br /> IState of Incorporation, or if not a corporation, State where business entity was formed: <br /> ' Washington <br /> If a co-partnership, give firm name under which business is transacted: <br /> IN/A <br /> ' *If a corporation, proposal must be executed in the corporate name by the president or vice-president(or any <br /> 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 /> 2022 PAVEMENT MAINTENANCE OVERLAY PAGE 28 OF 29 DIVISION P—WAGE COMPLIANCE <br /> IWORK ORDER 3764 FEBRUARY 23,2022 <br />