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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 />This form must be submitted with the Bid Proposal or as a Supplement to the Bid <br />no later than 24 hours after the time for delivery of the Bid Proposal, as provided <br />for in Section 1-02.9 of the Contract Provisions. <br />Certification of Compliance with Wage Payment Statutes <br />The bidder hereby certifies that, within the three-year period immediately preceding the bid <br />solicitation date (July 30, 2024), the bidder is not a willful violator, as defined in RCW 49.48.082 , <br />of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding <br />citation and notice of assessment issued by the Dep artment of Labor and Industries or through a <br />civil judgment entered by a court of limited or gen eral jurisdiction. <br />I certify under penalty of perjury under the laws o f the State of Washington that the foregoing is <br />true and correct. <br /> <br />Bidders Business Name <br />Signature of Authorized Official* <br />Printed Name <br />Title <br />Date City State <br />Check One: <br />Sole Proprietorship ☐ Partnership ☐ Joint Venture ☐ Corporation ☐ <br />State of Incorporation, or if not a corporation, St ate where business entity was formed: <br />If a co-partnership, give firm name under which bus iness is transacted: <br />* If a corporation, proposal must be executed in the corporate name by the president or vice-president <br />(or any other corporate officer accompanied by evidence of authority to sign). If a co-partnership, <br />proposal must be executed by a partner.