Laserfiche WebLink
CITY OF SANTA ANA <br />PR 10-6712,10-6713, 10 -6714 & 10 -6715 <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 <br />be insured against liability for worker's compensation or to undertake self - insurance in accordance <br />with the provisions of the Code, and I will comply with such provisions before commencing the <br />performance of 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 <br />employer under California Labor Code Section 3300, unless the hired employee(s) is (are) persons <br />excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate <br />from my workers' compensation insurance carrier certifying that I carry such insurance and that the <br />policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written <br />notice to the City of Santa A}la. — AN <br />Signed <br />• Title <br />Firm <br />Date <br />is <br />M <br />Calitomia Pmfesstcmal Engineering <br />q 1,2 G I 1,r.-, <br />BP 10 of 15 <br />TO BE INCLUDED IN BID PACKAGE <br />