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10 <br /> <br />City of Everett REQUEST FOR QUALIFICATIONS <br />RFQ No. 2023-164 <br />Walter E. Hall Park Community Connections Path <br /> <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 a reason for a determination of non-responsibility by <br />the City of Everett. <br /> <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 /> <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 /> <br /> <br />Board & Vellum <br />Seattle WA 98112 <br />LLC <br />www.boardandvellum.com <br />Leslie Batten Senior Associate <br />leslie@boardandvellum.com 206-673-2450 <br />Zack Thomas Principal <br />zack@boardandvellum.com 206-829-8587 <br />February 14, 2024 <br />27-5565006 603090966 <br />115 15th Avenue East