Supplemental Contractor Verification of ComplianceSUPPLEMENTAL CONTRACTOR VERIFICATION OF COMPLIANCE
By signing this document I certify that I am an owner or officer of the company, and I swear under
oath that:
My company meets each of the minimum criteria of Minn. Stat. § 16C.285, subd. 3, the
Responsible Contractor statute.
Pursuant to Stat. § 16C.285, subd. 3(7), my company has obtained from all
subcontractors and motor carriers with which it will have a direct contractual relationship a signed
statement under oath by an owner or officer verifying that they meet all of the minimum criteria in
subdivision 3 prior to execution of a construction contract with each subcontractor or motor
carrier.
The undersigned agrees that, if it retains additional subcontractors on the project after
submitting its verification of compliance, it shall obtain verifications of compliance from each
additional subcontractor with which it has a direct contractual relationship and shall submit a
supplemental verification confirming compliance with Minn. Stat. § 16C.285, subd. 3(7), within 14
days of retaining the additional subcontractors.
Upon request, the undersigned shall submit to the contracting authority copies of the
signed verifications of compliance from all subcontractors of any tier and all motor carriers
providing for -hire transportation of materials, equipment, or supplies for a project.
The undersigned understands that a failure to meet or verify compliance with the
minimum criteria established for a "responsible contractor" as defined in Minn. Stat. § 16C.285,
subd. 3, renders a bidder ineligible to be awarded a construction contract for the Project or to
perform work on the Project.
The undersigned understands that a false statement under oath verifying compliance with
any of the minimum criteria shall make the undersigned, ineligible to be awarded a construction
project and may result in termination of a contract awarded to the undersigned. A contracting
authority shall not be liable for declining to award a contract or terminating a contract based on a
reasonable determination that the contractor failed to verify compliance with the minimum criteria
or falsely stated that it meets the minimum criteria.
Date: 08/02/18
Contractor:
Sir Lines -A -Lot
By Dan Harvey
p 'nf name)
Signature
(please sign name)
Its President
2018 PAVEMENT MARKING PROJECT SUPPLEMENTAL VERIFICATION
CITY OF SHOREWOOD, MN
WSB PROJECT NO.R- 011854 -000