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I <br /> I = This form must be submitted with the Bid Proposal or as a Supplement <br /> to the Bid no later than 24 hours after the time for delivery of the Bid <br /> EVERETT Proposal, as provided for in Section 1-02.9 of the Contract Provisions. <br /> IWASHINGTON <br /> Certification of Compliance with Wage Payment Statutes <br /> IThe bidder hereby certifies that, within the three-year period immediately preceding the <br /> solicitation date November 15, 2022, the bidder is not a "willful" violator, as defined <br /> Ibid <br /> in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as <br /> determined by a final and binding citation and notice of assessment issued by the <br /> Department of Labor and Industries or through a civil judgment entered by a court of <br /> Ilimited or general jurisdiction. <br /> I I certify under penalty of perjury under the laws of the State of Washington that the <br /> foregoing is true and correct. <br /> \Ii�� LLC <br /> IBidder's siness Name <br /> ISignature of Authorized Official* <br /> I 4/101A S C)iln <br /> Printed Name <br /> Title <br /> Date City where signed State <br /> ICheck One: <br /> Sole Proprietorship ❑ Partnership Joint Venture ❑ Corporation ❑ <br /> IState of Incorporation, or if not a corporation, State where business entity was formed: <br /> V)oYSl11111t+ron <br /> IIf a co-partnership, give firm name under which business is transacted: <br /> I <br /> I <br /> CITY OF EVERETT PROPOSAL <br /> I FLEMING BICYCLE CORRIDOR 08(18!2022 <br /> FEDERAL AID#CM-0420(027);COE#PW3767 <br /> IPage 27 01 30 <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale <br />