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I <br /> City of Everett 00 45 39 - 2 I <br /> Water Filter Plant Portal 4 Improvements WO# 3755 <br /> Minority Goods or Certification <br /> Business Name Address Services Number* <br /> Involved <br /> ,Ww 2_3100 SF 2c,y+�51- DZFool<Ic.--lo <br /> . i-rPGK- 1 n G Map►t Vailt�,wA- 1c101356 '(r vU(-;,Arl u12F oo►9 p10 <br /> j1.oi51-8t-4 I2►Z NOcA kc.� Ave M2*.I I t5Mo01-0°1g2 <br /> r'tekl LAC eve so,n,vuA ac62-icQ Stems Sclop1,, MSM noZogq 2. I <br /> Puget SDov,a at ot, TKW-d ftvG s Et , r pzGooz2 i-ic <br /> Si- - Co IAG• Kent- u?A- Iclo3Z Suyppl++�� w2Fpo2ZuS- <br /> MA5ort Z0112'1oq-"AiNrt Web- cddivt,i5 pZF000a50CD <br /> COCAi-irto\s f5laci-1),Q(,lers�t10.v)4Cli4UU WZF000a6oce <br /> Le e vo Gn5 630 11'Pm- <br /> Co a_A:v`ctS 4Q2F 0ot2lz <br /> C 0 i porcosof 'yYrY-\c.t'nct,tn)Pr cri,t13 <br /> *Certification numbers (for MBE, MWBE, DBE, etc.) are found at Office of Minority&Women's <br /> Business Enterprises: https//omwbe diversitycomphance com/FrontEnd/SearchCertifledDirectory asp. <br /> If a minority business does not have a certification number, the Bidder must provide with this I <br /> certification form evidence that the business is at least fifty-one percent owned by minority <br /> group members. <br /> During Contract performance, or in any event prior to final payment, Bidder shall provide <br /> the City with the names and addresses of all minority businesses actually awarded <br /> subcontracts under the Contract. In the event that a subcontract bid or quote is solicited <br /> and listed above and a subcontract is not awarded to the minority business so listed, <br /> Contractor shall state the reasons such subcontract was not awarded to the minority <br /> business and shall provide the minority business quote together with the actual <br /> subcontract price paid and the name of the subcontractor to whom the subcontract was <br /> subsequently awarded. I <br /> FAILURE TO PROPERLY COMPLETE AND SUBMIT THIS CERTIFICATION FORM <br /> WITH THE BID WILL RESULT IN REJECTION OF BID. THE BIDDER CERTIFIES I <br /> UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF <br /> WASHINGTON THAT THE ABOVE IS TRUE AND COMPLETE CORRECT TO THE <br /> BEST OF ITS KNOWLEDGE AND BELIEF AND FURTHER AGREES TO PROVIDE <br /> INFORMATION AS REQUESTED BY THE CITY REGARDING MINORITY BUSINESS I <br /> SUBCONTRACTS AND EMPLOYMENT OF MINORITY GROUP MEMBERS. <br /> Signature: IIjj�� VV4.v % Date: October 11, 2022 <br /> Tyler tmbera y- President / CEO <br /> ciND OF SECTION 00 45 39 <br /> I <br /> I <br /> I <br /> I <br /> 00 45 39 - 2 RCW 35.22.650 CERTIFICATION <br /> I <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />