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• <br />CITY OF SAN'T'A ANA <br />RESIDENTIAL STREET REPAIR <br />RECONSTRUCTION - PHASE l l <br />PROJF,CT NO. 10-b717-C <br />PROPOSAL AND CONTRACT AGREEMENT <br />WORKERS' COMPENSATION INSURANCE CF,RTIFICATION <br />As required by California Labor Code Section 1860 and l 861, 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 perforn~ance of <br />the wark of this contract. <br />If I, as the Contractor, now or at any time during the course of this agreement, qualify as an employer <br />under California Labor Code Section 3300, unless the hired employee(s) is (are) persons excluded by <br />said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate from my workers' <br />compensation insurance carrier certifying that I carry such insurance and that the policy shall not be <br />canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa <br />Ana. _ <br />Signed X <br />Title Michael J. Carver, President <br />Firm R.J. Noble Company <br />Date 02/18/2010 <br />TO BE INCLUDED IN I3ID PACKAGE <br />BP9ofl4 <br />