Laserfiche WebLink
13 <br />City of Everett REQUEST FOR QUALIFICATIONS #2023-093 <br />EVERETT MAIN LIBRARY HVAC and CONTROLS REPLACEMENT <br />SOUTH PRECINCT CONTROLS REPLACEMENT and MAINTENANCE <br />EVERETT STATION CONTROLS REPLACEMENT and MAINTENANCE <br />The undersigned hereby declares that he or she is duly authorized to complete and submit this Statement of <br />Qualifications and that the statements contained herein are true and correct as of the date set forth below. <br />Incomplete, incorrect or misleading information may be reason for a determination of non-responsibility by the City of <br />Everett. <br />Company Name: <br />Company Address: <br />City: State: ZIP: <br />Tax ID #: UBI #: <br />Legal status of supplier organization, i.e., corporation, partnership, sole proprietorship. <br />Diversity Certification (if applicable): ☐ Disadvantaged Business Enterprise (DBE) ☐ Minority Business Enterprise (MBE) ☐ Women Business <br />Enterprise (WBE) ☐ Minority Women Business Enterprise (MWBE) Certification number: <br />Website: City of Everett Business License # <br />Supplier Contact Name (if different from Authorizing Official): Supplier Contact Title: <br />Supplier Contact Email: Supplier Contact Direct Phone: <br />Supplier Contact Address (if different from above): <br />City: State: ZIP: <br />Authorizing Official Name: Authorizing Official Title: <br />Authorizing Official Email: Authorizing Official Phone: <br />Authorizing Official Signature* and Date: <br />*A signature means an original signature, a copy of an original signature, a PDF scan of an original signature, or a DocuSign/AdobeSign electronic <br />signature. <br />Hultz/BHU Engineers, Inc. <br />N/A <br />Tacoma Washington 98402 <br />91-1282644 <br />www.hultzbhu.com <br />Rick Hultz President <br />rickh@hultzbhu.com 253.383.3257 <br />601 589 566 <br />Corporation <br />1111 Fawcett Avenue, Suite 100 <br />66610 <br />October 24, 2023