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Section 00 41 13 BID FORM <br /> 1 1.09 BID FORM SIGNATURES <br /> A, By submitting this Bid, Bidder certifies that it has reviewed the insurance <br /> requirements of Document 00 72 00, GENERAL CONDITIONS and certifies that <br /> coverage will be provided as required. <br /> iB. The undersigned Bidder 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. <br /> Signed this 7th day of March , 2023 <br /> Name of Bidder: McClure and Sons, Inc. <br /> Signature of Bidder's Authorized Agent: cm <br /> ' Title: President ✓ <br /> Phone: (425) 316-6999 <br /> ' City and State Where Signed: Mill Creek WA <br /> State of Incorporation Washington Contractor's License No. MCCLUSI101 MJ <br /> ' Washington State Yes <br /> Email address of Bidder's authorized Agent: <br /> les@mcclureandsons.com bids@mcclureandsons.com <br /> PART 2 : PRODUCTS <br /> Not Used. <br /> PART 3 : EXECUTION <br /> Not Used. <br /> END OF SECTION 00 41 13 <br /> I <br /> i <br /> 1 <br /> City of Everett 00 41 13-5 February 2023 <br /> Evergreen Pump Station Modifications <br /> UP3747-3 <br /> i <br />