ATTACHMENT D Wage Cert.pdf
PDF 129 KB Posted
- Attached to
- VENDING SERVICES
- Solicitation number
- RFP# 2025-05-15
- Issued by
- King County, Snohomish County, Kingston CDP, Snohomish City, Washington
About this file
Attachment D is a Contractor Certification document from Northshore School District No. 417 for a Vending Services Request for Proposal (RFP# 2025-05-15), focusing on wage theft prevention and responsible bidder criteria. The document is a mandatory certification form that bidders must complete, requiring contractors to declare whether they have willfully violated Washington state wage laws within the past three years prior to the procurement solicitation date.
The certification form requires bidders to check one of two options: either affirming no wage law violations or acknowledging specific violations of Washington Revised Code (RCW) chapters related to wage regulations. By signing the document, the authorized representative certifies under penalty of perjury that the statements are true and provides their firm's information, including name, signature, title, location, and date. This document is part of the district's procurement process to ensure responsible contracting and compliance with state labor regulations for the upcoming vending services contract.
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Text version
NORTHSHORE SCHOOL DISTRICT NO. 417
VENDING SERVICES RFP# 2025-05-15
ATTACHMENT D
CONTRACTOR CERTIFICATION
Wage Theft Prevention – Responsible Bidder Criteria
Northshore School District Goods & Services Contracts
Prior to awarding a contract, Northshore School District is required to determine that a bidder is a ‘responsible bidder’. Pursuant to legislative enactment in 2017, RCW 39.26.160(2) & (4) requires responsible bidder criteria to include contractor certification that the contractor has not willfully violated Washington’s wage laws.
On behalf of the firm identified below, I hereby certify 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 49.52within 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 Print Name of person making certifications for firm
Title: Place:
Print city and state where signed Title of person signing certificate
Date:
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
| CONTRACTOR CERTIFICATION |
| On behalf of the firm identified below, I hereby certify as follows (check one): |
| Firm Name: |
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