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Certification of Compliance with Wage Payment <br /> • ;f Statutes <br /> The bidder hereby certifies that, within the three-year period immediately preceding the bid <br /> solicitation date March 27, 2018, 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 Department of Labor and Industries or through a civil <br /> judgment entered by a court of limited or general jurisdiction. I <br /> I certify under penalty of perjury under the laws of the State of Washington that the foregoing is <br /> true and correct. <br /> Bidder's Business Name <br /> Signature of Authorized Official* 1 <br /> Printed Name <br /> Title I <br /> Date City State <br /> Check One: <br /> Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation ❑ <br /> State of Incorporation, or if not a corporation, State where business entity was formed: <br /> I <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 vice-president (or <br /> any other corporate officer accompanied by evidence of authority to sign). If a co-partnership, proposal must <br /> be executed by a partner. <br /> HOT MIX ASPHALT OVERLAY-2018 PAGE 14 OF 14 MARCH 6, 2018 <br /> WORK ORDER#3667 <br /> DIVISION P <br /> I <br />