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Adft <br />V 0 V4~on state <br />A D"mwbrient of Transportation <br />Contractor Certification <br />Wage Law Compliance - Responsibility Criteria <br />Washington State Public Works Contracts <br />FAILURE TO RETURN THIS CERTIFICATION AS PART OF THE BID PROPOSAL PACKAGE WILL <br />MAKE THIS BID NONRESPONSIVE AND INELIGIBLE FOR AWARD <br />I hereby certify, under penalty of perjury under the laws of the State of Washington, on behalf of the firm <br />identified Wow that, to the best of my knowledge and belief, this firm has N_QLT been determined by a final <br />and binding citation and notice of assessment issued by the Washington State Department of Labor and <br />Industries or through a civil judgment entered by a court of limited or general jurisdiction to have wilfully <br />violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three <br />(3) years prior to the date of the Call for Bids. <br />Bidder Name: Gibson & Son Road Building, INC. <br />Name of Contractorl'Bidder - Print ful legal entity same of firm <br />By: --Kory Gibson <br />Pnnt. Name of person making Signattire authorized person certifications for firm <br />Title: Vice President <br />Title of person signing certificate <br />Date: 3/2/2026 <br />Fo+ 272-009 <br />OPUZO 17 <br />Kittitas County <br />Cle Elum Transfer Station <br />Driveway Improvements and Tank Replacement Project <br />Place: —Ellensburg, WA <br />Print city and state where signed <br />Bid Documents <br />