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<br />CITY OF SANTA ANA <br /> <br />• PROJECT NO. 08-5017: TRAFFIC SIGNAL INSTALLATION ON WILLITS ST & SULLIVAN ST <br />PROJECT NO. 08-5021: TRAFFIC SIGNAL INSTALLATION ON RAITT ST & GLENWOOD AVE <br />PROJECT NO. 08-5022: TRAFFIC SIGNAL INSTALLATION ON HARBOR BLVD & KENT AVE <br />PROJECT NO. 08-5023: TRAFFIC SIGNAL MODIFICATION ON SANTA ANA BL & FLOWER ST <br />PROPOSAL AND CONTRACT AGREEMENT <br />WORKERS' COMPENSATION INSURANCE CERTIFICATION <br />As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: <br />I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be <br />insured against liability for worker's compensation or to undertake self-insurance in accordance with the <br />provisions of the Code, and I will comply with such provisions before commencing the performance of the <br />work of this contract. <br />If I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer under <br />California Labor Code Section 3300, unless the hired employee(s) is (are) persons excluded by said Labor <br />Code, I shall furnish the City of Santa A ith an insurance certificate from my workers' compensation <br />insurance carrier certifying that I carry uch nsurance and that the policy shall not be canceled nor the <br />coverage reduced excepty~ c thirt~.~30 ay prior written notice to the City of Santa Ana. <br />• Signed ~/ ""~'" <br />Title L~N~-~-tJ c=N1~1 ,~ <br />Firm LINCOLN PACIFlC BUILDERS, WC <br />Date 02.24-~ ~~ <br /> <br />TO BE INCLUDED IN BID PACKAGE <br />BP 10 of 34 <br />