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I I CITY OF EVERETT PUBLIC WORKS 00 45 46 SPECIAL PROVISIONS CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES IDOCUMENT 00 45 46-CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES 1 1.1 RELATED SECTIONS A. DOCUMENT 00 21 13—INSTRUCTIONS TO BIDDERS 1 1.2 REQUIREMENT A. In order to meet Mandatory Responsibility Criteria per RCW 39.04.350(1), apparent lowest I responsive bidder shall complete and submit this document to Owner prior to Owner awarding Contract. The bidder hereby certifies that, within the three-year period immediately preceding the bid I solicitation date <Insert Bid Date Here>, the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and I Industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I6k-6I!ar J Cor porakon B' Busine Nri_ S' ature of Authorized Official* ', K, ern IPrinted Na e W7-68‘a OA(\. -- I Ti 1 zOld \A/Witt-not 1n1 1 Date City State Check One: I Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation ii State of Incorporation, or if not a corporation, State where business entity was formed: IIf a co-partnership, give firm name under which business is transacted: 1 *If a corporation,proposal must be executed in the corporate name by the president or vice-president(or any other corporate officer accompanied by evidence of authority to sign). If a co-partnership,proposal must be executed by a partner. 1 END OF DOCUMENT I PROCESS WATER PUMP STATION April 19, 2018 WO-3647 00 45 46- 1 1