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CITY OF SANTA ANA <br />LOCAL STREET PAVEMENT REHABiLI"CATION <br />RESIDENTIAL STREET REPAIR -PHASE 1 O <br />PROJECT NO_ 10-6707-C <br />PROPOSAL AND CON'T'RACT AGREEMENT <br />WORKERS' COMPF_NSATION INSURANCE CERTIFICATION <br />As required by California Labor Code Section 1860 and 1861, the Contractor certifies as ti?llows <br />i am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be <br />insured against liability t7x worker's compensation or to undertake self-insurance ]n accordance with the <br />provisions of the Codc, and 1 will comply with such provisions before commencing the perforrnancc of <br />the work of this contracC. <br />if I, as the C:ontractor, now or at any time during the course of this agreement, qualify as an employer <br />under California Labor Codc 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 [hat the policy shall not he <br />canceled nor the coverage reduced except upon thirty (30) days prior written notice to the City of Santa <br />Ana. <br />Signed <br />Title Steve MenBoza, Secretary <br />Firm R.J. Noble Company <br />Date 11/10/09 <br />TO BE INCLUDED IN BID PAC:K.AC.7I <br />BP9of14