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render the prime contractor or subcontractor that makes the false statement ineligible to be awarded a construction <br />contract on the project for which the verification was submitted. <br />A false statement under oath verifying compliance with any of the minimum criteria may result in termination of a <br />construction contract that has already been awarded to a prime contractor or subcontractor that submits a false <br />statement. A contracting authority shall not be liable for declining to award a contract or terminating a contract based on <br />a reasonable determination that the contractor failed to verify compliance with the minimum criteria or falsely stated <br />that it meets the minimum criteria. <br />CERTIFICATION <br />By signing this document I certify that I am an owner or officer of the company, and I swear under oath that: <br />1) My company meets each of the Minimum Criteria to be a responsible contractor as defined herein and is in <br />compliance with Minn. Stat. § 16C.285, <br />2) 1 have included a First Tier Subcontractors List with my company's solicitation response, and <br />3) if my company is awarded a contract, I will also submit the Additional Subcontractors List as required. <br />Authorized Signature QLOWner or Officer: <br />Printed Name: <br />Title: <br />Date: <br />C' <br />ZA3(Z <br />Company Name: <br />NORTHWEST ASPHALT, INC. <br />14,51 STAGECOACH ROAD <br />SHAKOPEE9 MN 5537 <br />Sworn -to ands scribed before me this <br />day of /YI 20ZJ <br />Notary Public <br />My Commission Expires: Zs <br />LONDON RYAN NOPOLA <br />Notary Public <br />N0TA1W&WAbtg HERE <br />My Commission Expires <br />Jan 31, 2025 <br />NOTE: Minn. Stat. § 16C.285, Subd. 2, (c) If only one prime contractor responds to a solicitation document, a contracting <br />authority may award a construction contract to the responding prime contractor even if the minimum criteria in <br />subdivision 3 are not met. <br />Responsible Contractor Certificate <br />00 4514-3 <br />