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Bidder agrees to provide upon written request of the City all information related to its <br />qualifications and those of its key personnel and its proposed Subcontractors. <br />Bidder certifies that its Bid is in all respects fair, and is made without collusion on the part of any <br />person, firm, or corporation mentioned below, and that no officer or employee of the City is <br />personally or financially interested, directly or indirectly, in the Bid, or in any purposes of, or the <br />sale of, any materials or supplies for the work to which it relates, or any portion of the profits <br />thereof. <br />DESIGNATED/AUTHORIZED REPRESENTATIVE <br />Bidder designates of its office to which notice of <br />acceptance of this Bid may be mailed, emailed or delivered. <br />City may provide notice of any kind to the Bidder using the email address Bidder provides <br />below. <br />A notice is considered delivered to the Bidder on the date it is emailed to the email address. <br />INTERESTED PARTIES <br />The full names and residences of all persons and parties interested in this Bid as principals are <br />as follows: <br />NAME <br />TITLE ADDRESS <br />BID FORM SIGNATURES <br />By submitting this Bid, Bidder certifies that it has reviewed the insurance requirements of <br />Document 00 72 00 — GENERAL CONDITIONS and certifies that coverage will be provided as <br />required. <br />The undersigned also hereby certifies that, within the three-year period immediately preceding <br />the bid solicitation date for this Project, the Bidder has not been determined by a final and <br />binding citation and notice of assessment issued by the department of labor and industries or <br />through a civil judgment entered by a court of limited or general jurisdiction to have willfully <br />violated, as defined in RCW 49.48.082, any provision of chapter 49.46, 49.48, or 49.52 RCW. <br />The undersigned declares under penalty of perjury under the laws of the State of Washington <br />that the foregoing sentence is true and correct. <br />Signed this day of , 20 <br />Name of Bidder: <br />Signature of Bidder's Authorized Agent: <br />City and State Where Signed: <br />Title: <br />Reservoir 3 Replacement Phase 1 <br />Work Order No. UP3739 <br />BID FORM <br />00 41 13 <br />March 2024 <br />