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<br />Page 24 of 43 <br /> <br /> <br />FORM 3.0 3 CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES <br />INVITATION FOR BID #2022-047 <br />UNIT PRICE HVAC SERVICES AND REPAIRS <br /> <br />The Contractor hereby certifies that, within the three -year period immediately preceding the <br />solicitation d ue date (September 27 , 20 2 2 ), the Contractor is not a “willful” violator, as defined in <br />RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final <br />and binding citation and notice of assessment issued by the Department of Labor and Industries <br />or through a civil j udgment entered by a court of limited or general jurisdiction. <br /> <br />I certify under penalty of perjury under the laws of the State of Washington that the foregoing is <br />true and correct. <br /> <br /> <br />Contractor ’s Business Name <br /> <br /> <br />Signature of Authorized Official* <br /> <br /> <br />Printed Name <br /> <br /> <br />Title <br /> <br /> <br />Date <br /> <br />City <br /> <br />State <br />Check One: <br />Sole Proprietorship ☐ Partnership ☐ Joint Venture ☐ Corporation ☐ <br /> <br />State of Incorporation, or if not a corporation, State where business entity was formed: <br /> <br /> <br />If a co-partnership, give firm name under which business is transacted: <br /> <br /> <br />* If a corporation, proposal must be executed in the corporate name by the president or vice -president (or <br />any other corporate officer accompanied by evidence of authority to sign). If a co-partnership, proposal <br />must be executed by a partner. <br />