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I <br /> City of Everett 00 4113 - 3 <br /> I <br /> Evergreen Branch Library Expansion 2017-008 <br /> NAME TITLE ADDRESS <br /> I1 1,1 .1),91/-firtiv Vick-Taft-14-- 141 i 4_054- 71-/y6or 174grA-1,ki‘i iz''.4cif <br /> qg <br /> 1 <br /> 1 15. By submitting this Bid, Bidder certifies that it has reviewed the insurance requirements of <br /> the General Conditions and certifies that coverage will be provided as required. <br /> I <br /> Signed this day of 06'6 , 20 b <br /> IBidder Firm N.me: 14' 1 1j .t, (a-P <br /> Signature: 4 <br /> \ <br /> I Title: VI V*-, n <br /> ' Address: 01 d • <br /> City/Zip: 911-,A, Vvo <br /> Phone. 4IDuJl., <br /> ,,,,,4.,,-.----_, ��iqiiss <br /> I State orporation Contractor's License No. <br /> Washington State <br /> Bpl1l`lc�� <br /> IU Number <br /> IEmployment Security Account No. <br /> ISUBSCRIBED and SWORN to before me this V) day of V — , 20 K <br /> . , j 4._____ <br /> • A'R' 'UBLIC in and for the State of Washington ;UN��,.. <br /> My Appointment Expires: 4,3101 .9-tarli <br /> :-.t4 %• <br /> O g <br /> IEND OF SECTION 00 4113 v',�% �°UBl�G <br /> IIk%v ;; ,_ <br /> 00 4113 - 3 BID FORM <br /> I <br />