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IN <br /> MI <br /> \� Satin <br /> INDUSTRIAL CONTRACTORS <br /> McClure and Sons Inc. <br /> HOLD HARMLESS STATEMENT <br /> Contract No: Work Order # UP3742-3 <br /> Contract Title: WPCF Trickling Filter#1 Media Replacement <br /> Contractor: McClure & Sons, Inc. <br /> I, the undersigned, as the duly authorized representative for the above-named Contractor, hereby <br /> certify that all Work has been performed and materials supplied in accordance with the Contract <br /> Documents for the above mention Project, and that: <br /> 1) No less than the prevailing wage rates have been paid as required in the Contract. <br /> 2) All firms supplying labor or materials have an approved "Statement of Intent to Pay <br /> Prevailing Wages"and "Affidavit of Wages Paid"by the Washington State Department <br /> of Labor and Industry on file for this Project. <br /> 3) All claims by subcontractors and suppliers for materials, labor and/ or other services <br /> performed in connection with the Contract have been satisfied by the Contractor. All <br /> claims by the Contractor for materials, labor and/ or other services performed in <br /> connection with the Contract have been satisfied by The City of Everett, except if <br /> specifically exempted as described below. <br /> 4) All federal, State and County mandated insurance premiums have been paid for the <br /> Contractor and all sub-contractors for this Project. <br /> 5) Our worker's compensation premiums have been paid to the Washington State <br /> Department of Labor and Industries current with the contract completion; amounts <br /> due under the Employment Security Act have been paid in full for the contract; all <br /> excise taxes due have been paid to the Washington State Department of Revenue. <br /> I, also certify under penalty of perjury, that all persons performing labor or furnishing materials in <br /> connection with the performance of this contract have been paid in accordance with the terms <br /> and conditions of the Contract and all applicable State laws. I hereby grant a release of, and <br /> agree to defend, hold harmless and indemnify City of Everett against all claims of any nature <br /> whatsoever arising under virtue of this Contract, including any subcontract, purchase order or <br /> agreement providing labor or materials in connection with the performance of this Contract; other <br /> than such claims, if any, as are specifically exempted by the Contractor from the operation of this <br /> release by identification of the specific claim and approximate amount as set forth below. <br /> Contractor's Authorized Representative: <br /> Les McClure, President <br /> l♦ <br /> Printed :me&Title <br /> „dinrlla 2 � • l • 2o2 , <br /> S'tnature Date <br /> 15714 Country Club Drive, Mill Creek, WA 98012 • FAX: 425 316-6789, Office: 425 316-6999 <br />