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City of Everett <br />MINORITY CERTIFICATION <br />CITY OF EVERETT WEST MARINE VIEW DRIVE/ALVERSON AND 41 ST ST/GRAND AVE <br />PEDESTRIAN IMPROVEMENTS <br />STATE FUND# HLP-PB15(032) <br />WO #3630 July 10, 2024 <br />Minority <br />Business Name Address <br />Goods or <br />Services <br />Involved <br />Certification <br />Number* <br />*Certification numbers (for MBE, MWBE, DBE, etc.) are found at Office of Minority & Women’s <br />Business Enterprises: https://omwbe.diversitycompliance.com/FrontEnd/SearchCertifiedDirectory.asp. <br />If a minority business does not have a certification number, the Bidder must provide with this <br />certification form evidence that the business is at least fifty-one percent owned by minority <br />group members. <br />During Contract performance, or in any event prior to final payment, Bidder shall provide <br />the City with the names and addresses of all minority businesses actually awarded <br />subcontracts under the Contract. In the event that a subcontract bid or quote is solicited <br />and listed above and a subcontract is not awarded to the minority business so listed, <br />Contractor shall state the reasons such subcontract was not awarded to the minority <br />business and shall provide the minority business quote together with the actual <br />subcontract price paid and the name of the subcontractor to whom the subcontract was <br />subsequently awarded. <br />FAILURE TO PROPERLY COMPLETE AND SUBMIT THIS CERTIFICATION FORM <br />WITH THE BID WILL RESULT IN REJECTION OF BID. THE BIDDER CERTIFIES <br />UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF <br />WASHINGTON THAT THE ABOVE IS TRUE AND COMPLETE CORRECT TO THE <br />BEST OF ITS KNOWLEDGE AND BELIEF AND FURTHER AGREES TO PROVIDE <br />INFORMATION AS REQUESTED BY THE CITY REGARDING MINORITY BUSINESS <br />SUBCONTRACTS AND EMPLOYMENT OF MINORITY GROUP MEMBERS. <br />Signature: ___________________________________ Date: __________________