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CITY OF EVERETT PUBLIC WORKS 00 45 46 <br /> ' SPECIAL PROVISIONS CERTIFICATION OF COMPLIANCE WITH <br /> WAGE PAYMENT STATUTES <br /> ' DOCUMENT 00 45 46-CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES <br /> 1.1 RELATED SECTIONS <br /> ' A. DOCUMENT 00 21 13 —INSTRUCTIONS TO BIDDERS <br /> 1.2 REQUIREMENT <br /> A. In order to meet Mandatory Responsibility Criteria per RCW 39.04.350(1), apparent lowest <br /> ' responsive bidder shall complete and submit this document to Owner prior to Owner awarding <br /> Contract. <br /> The bidder hereby certifies that, within the three-year period immediately preceding the bid <br /> ' solicitation date January 9th, 2018, 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 <br /> and binding citation and notice of assessment issued by the Department of Labor and Industries <br /> ' or through a civil judgment entered by a court of limited or general jurisdiction. <br /> I certify under penalty of perjury under the laws of the State of Washington that the foregoing is <br /> true and correct. <br /> R6 <br /> do1yrviCons vtiun Inc. <br /> Bidder's Business Name <br /> Signature of Authorized Officio <br /> Tvmw 1-Zcidanm,, <br /> ' Printed Name <br /> Pres i dl,r► r <br /> ' Title <br /> 1 /Glints( 1\-\AhArri, wtr <br /> Date City State <br /> ' Check One: <br /> Sole Proprietorship D Partnership ❑ Joint Venture ❑ Corporation <br /> Stat of Incorporation,or if not a corporation, State where business entity was formed: <br /> 7,01 om <br /> If a co-partnership,give firm name under which business is transacted: <br /> * If a corporation,proposal must be executed in the corporate name by the president or <br /> vice-president (or any other corporate officer accompanied by evidence of authority to <br /> sign). If a co-partnership,proposal must be executed by a partner. <br /> ' END OF DOCUMENT 00 45 46 <br /> Legion Golf Course Stormwater Detention Project November 30,2017 <br /> ' WO#UP3620 00 45 46- 1 <br />