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<br />Lenora Regional SW Facility Division P – Proposal Nov. 2025 <br />Work Order # UP3792 SP - xxxiv <br />Category 2: For official use only / disclosure permissible by law. <br />Minority Business Name Address Goods or Services Involved Certification Number* <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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. If a <br />minority business does not have a certification number, the Bidder must provide with this certification <br />form evidence that the business is at least fifty-one percent owned by minority group members. <br />During Contract performance, or in any event prior to final payment, Bidder shall provide the City with <br />the names and addresses of all minority businesses actually awarded subcontracts under the Contract. <br />In the event that a subcontract bid or quote is solicited and listed above and a subcontract is not awarded <br />to the minority business so listed, Contractor shall state the reasons such subcontract was not awarded <br />to the minority 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 subsequently <br />awarded. <br /> <br />FAILURE TO PROPERLY COMPLETE AND SUBMIT THIS CERTIFICATION FORM WITH THE BID WILL RESULT IN REJECTION OF BID. THE BIDDER CERTIFIES UNDER PENALTY OF PERJURY <br />UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE ABOVE IS TRUE AND <br />COMPLETE CORRECT TO THE BEST OF ITS KNOWLEDGE AND BELIEF AND FURTHER AGREES <br />TO PROVIDE INFORMATION AS REQUESTED BY THE CITY REGARDING MINORITY BUSINESS <br />SUBCONTRACTS AND EMPLOYMENT OF MINORITY GROUP MEMBERS. <br /> <br /> <br /> <br />Signature: ___________________________________ Date: __________________