ATTACHMENT D Wage Cert.pdf
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- Attached to
- K-5 MATHEMATICS CURRICULUM MATERIALS
- Solicitation number
- RFI# 2026-09-28
- Issued by
- Washington
About this file
This is a Contractor Certification form for Wage Theft Prevention and Responsible Bidder Criteria issued by Northshore School District in Washington in connection with an RFI for K-5 Mathematics Curriculum Materials (RFI# 2026-09-27). The District is seeking information from qualified publishers and developers of K-5 mathematics curriculum materials as part of a comprehensive curriculum adoption process. The District intends to pilot a new K-5 mathematics program during the 2027-28 school year, with full adoption to follow. The form must be completed and submitted by bidders as a requirement for contract award consideration.
As a condition of being deemed a responsible bidder under Washington State law (RCW 39.26.160(2) & (4)), contractors must certify their wage law compliance status. Bidders must declare under penalty of perjury whether their firm has or has not been determined by a final and binding citation from the Washington Department of Labor and Industries or through civil judgment to have willfully violated provisions of RCW chapters 49.46, 49.48, or 49.52 within three years prior to the procurement solicitation date. The certification requires the signature of an authorized representative of the firm, including the firm's legal name, the signatory's printed name and title, location, and date of certification.
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Text version
K–5 Mathematics Curriculum Materials
RFI# 2026-09-27
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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