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1 <br /> City of Everett 00 41 13 - 4 <br /> Police Firing Range Bullet Trap Replacement <br /> 1 <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 ' <br /> that coverage will be provided as required. <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 <br /> not been determined by a final and binding citation and notice of assessment <br /> issued by the department of labor and industries or through a civil judgment ' <br /> entered by a court of limited or general jurisdiction to have willfully violated, as <br /> defined in RCW 49.48.082, any provision of chapter 49.46, 49.48, or 49.52 <br /> RCW. The undersigned declares under penalty of perjury under the laws of the <br /> State of Washington that the foregoing sentence is true and correct. <br /> Signed this b- ( -2022- day of '374t1C.. 1 , 2022 <br /> Name of Bidder: ,4 4i't <br /> Signature of Bidder's Authorized Agent: <br /> City and State Where Signed: PR,va v 7 <br /> Title: CFO ' <br /> Phone: r 9( s' ' <br /> State of Incorporation 0 E Contractor's License No. ACTlO T l86W 1c F <br /> Washington State ‘0 3 /2 C c6-2 <br /> Email address of Bidder's authorized Agent: <br /> // <br /> SWi y47,eo 4c-0044:v76T,Co iy <br /> 00 41 13 - 4 BID FORM <br />