HomeMy WebLinkAboutAdden A - Certification of Compliance with Wage Payment Statutes 02-12-19 0
This form must be submitted with the Bid Proposal.
Certification of Compliance with Wage Payment Statutes
The bidder hereby certifies that, within the three-year period immediately preceding the bid
solicitation date, 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 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.
Bidder's Business Name
Signature of Authorized Official*
Printed Name
Title
Date City State
Check One:
Sole Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporation ❑ LLC ❑
State of Incorporation, or if not a corporation, State where business entity was formed:
If a co-partnership, give firm name under which business is transacted:
*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.
Template updated 2-12-19