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• CITY OF SANTA ANA <br /> PROJECT NO. 09-1751-C <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 <br /> the 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 <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 /> <br /> • Si ed <br /> ~obar+ B2~dle Y <br /> Title ~ j <br /> Firm ill /!lY1L'yl C~.V? ~-F <br /> Date ~ <br /> ,~r; I a ~g,~ ~I n <br /> • <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP8of13 <br /> <br />