28-25-728 Attachment 15 WageTheftForm.pdf
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- Solicitation number
- 2025-728
- Issued by
- King County, Washington
About this file
This is a Contractor Certification form required by the Washington State Department of Enterprise Services for public works contracts in compliance with wage theft prevention legislation enacted in 2017. The form applies to the GC/CM BC - Bellevue College Parking Garage Update project and must be returned with the signed Bid Form or within two business days of request by the Owner. The certification requires bidders to attest under penalty of perjury whether their firm has or has not been determined by final citation from the Washington Department of Labor and Industries or civil judgment to have willfully violated Washington wage laws within three years prior to the procurement solicitation date.
Bidders must select one of two certification options: either that the firm has not been determined to have willfully violated provisions of RCW chapters 49.46, 49.48, or 49.52, or that the firm has been so determined. The form requires the authorized company representative to provide the firm's legal name, signature, title, printed name, and the location where the certification was signed. This certification is a mandatory responsibility criterion for determining whether a contractor qualifies as a "responsible bidder" eligible for award of the Washington State public works project, as established under RCW 39.04.350.
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Attachment 15 - Contractor Certification
Attachment 15 - Contractor Certification
WAGE THEFT PREVENTION – RESPONSIBLE BIDDER CRITERIA
WASHINGTON STATE PUBLIC WORKS CONTRACTS
Return this signed “Contractor Certification” with your signed Bid Form or within two (2) business days of request by Owner.
Prior to awarding a public works contract, the Washington State Department of Enterprise Services is required to determine that a bidder meets the responsibility criteria to be considered a ‘responsible bidder’ and is qualified to be awarded a public works project. See RCW 39.04.350(1)(g) & (2). Pursuant to legislative enactment in 2017, the responsibility criteria include a contractor certification that the contractor has not willfully violated Washington’s wage laws. See Chap. 258, 2017 Laws (enacting SSB 5301).
Project No.:
Project Name:
Procurement Solicitation Date:
I hereby certify, on behalf of the firm identified below, as follows (check one):
NO WAGE VIOLATIONS. This firm has NOT been determined by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.
OR
VIOLATIONS OF WAGE LAWS. This firm has been determined by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, a provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.
I hereby certify, under penalty of perjury under the laws of the State of Washington, that the certifications herein are true and correct and that I am authorized to make these certifications on behalf of the firm listed herein.
FIRM NAME: _____________________________________________________
Name of Contractor/Bidder – Print full legal entity name of firm
By: ______________________________ Signature of authorized person
Title: ______________________________ Title of person signing certificate
Date: _______________________________
Print Name of person making certifications for firm
Place: _______________________________ Print city and state where signed http://app.leg.wa.gov/RCW/default.aspx?cite=39.04.350 http://app.leg.wa.gov/RCW/default.aspx?cite=49.48.082 http://app.leg.wa.gov/RCW/default.aspx?cite=49.46 http://app.leg.wa.gov/RCW/default.aspx?cite=49.48 http://app.leg.wa.gov/RCW/default.aspx?cite=49.52 http://app.leg.wa.gov/RCW/default.aspx?cite=49.48.082 http://app.leg.wa.gov/RCW/default.aspx?cite=49.46 http://app.leg.wa.gov/RCW/default.aspx?cite=49.48 http://app.leg.wa.gov/RCW/default.aspx?cite=49.52
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