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2026 Pavement Maintenance Overlay 3.01 Proposal Certification of Compliance with Wage Payment Statutes <br />PW# 3860 March 5, 2026 <br /> <br /> <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 /> <br />Certification of Compliance with Wage Payment Statutes <br />The bidder hereby certifies that, within the five -year period immediately preceding the bid <br />solicitation date (March 31, 2026 ), the bidder is not a “willful” violator, as defined in RCW <br />49.48.082, of any provision of chapters 49.46, 49 .48, or 49.52 RCW, as determined by a final and <br />binding citation and notice of assessment issued by the Department of Labor and Industries or <br />through a civil judgment 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 />Bidder ’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 w here business entity was formed: <br /> <br /> <br />If a co -partnership, give firm name unde r which business is transacted: <br /> <br /> <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.