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Section 00 41 13 BID FORM City of Everett 00 41 13-5 June 2024 WFP Air Scour Blower Building Replacement Issued for Bid UP3813 1.09 BID FORM SIGNATURES A. By submitting this Bid, Bidder certifies that it has reviewed the insurance requirements of Section 00 72 00 - GENERAL CONDITIONS and certifies that coverage will be provided as required. B. The undersigned also hereby certifies that, within the three-year period immediately preceding the bid solicitation date for this Project, the Bidder has not been determined by a final and binding citation and notice of assessment issued by the department of labor and industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of chapter 49.46, 49.48, or 49.52 RCW. The undersigned declares under penalty of perjury under the laws of the State of Washington that the foregoing sentence is true and correct. Signed this ___________ day of _______________________, 2024 Name of Bidder: _________________________________________ Signature of Bidder’s Authorized Agent: _______________________ Title: ______________________________ Phone: ____________________________ City and State Where Signed: _________________________ State of Incorporation _____________Contractor’s License No._________ Washington State___________ Email address of Bidder’s authorized Agent: PART 2 : PRODUCTS Not Used. PART 3 : EXECUTION Not Used. END OF SECTION 00 41 13