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I <br /> City of Everett 00 4113 -4 <br /> Inductive Charging Infrastructure for Everett Transit I <br /> r <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. I <br /> B. The undersigned also hereby certifies that, within the three-year period <br /> immediately preceding the bid solicitation date for this Project, the Bidder has not , <br /> 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 /> 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. I <br /> I <br /> Signed this day of , 2022 <br /> Name of Bidder: I <br /> Signature of Bidder's Authorized Agent: <br /> City and State Where Signed: <br /> Title: <br /> Phone: <br /> I <br /> State of Incorporation Contractor's License No. <br /> Washington State <br /> Email address of Bidder's authorized Agent: I <br /> I <br /> I <br /> 00 4113 - 4 BID FORM <br /> I <br />