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City of Everett 00 41 13 - 5 <br />Port Gardner Storage Facility - Demolition Package WO# UP-3525 <br />00 41 13 - 5 BID FORM <br />B. The undersigned also hereby certifies that, within the three-year period immediately <br />preceding the bid solicitation date for this Project, the Bidder has not been determined <br />by a final and binding citation and notice of assessment issued by the department of <br />labor and industries or through a civil judgment entered by a court of limited or general <br />jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of <br />chapter 49.46, 49.48, or 49.52 RCW. The undersigned declares under penalty of <br />perjury under the laws of the State of Washington that the foregoing sentence is true <br />and correct. <br />Signed this ___________ day of _______________________, 2024 <br />Name of Bidder: _________________________________________ <br />Signature of Bidder’s Authorized Agent: _______________________ <br />City and State Where Signed: ________________________ <br />Title: ______________________________ <br />Phone: ____________________________ <br />State of Incorporation _____________Contractor’s License No._________ <br />Washington State___________ <br />Email address of Bidder’s authorized Agent: <br />_______________________________ <br />END OF SECTION 00 41 13