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CITY OF SANTA ANA <br />PROJECT NO. 11-7508; LACY NEIGHBORHOOD SEWER AND WATER MAII?T <br />IMPROVEMENTS <br />PROPOSAL AND CONTRACT AGREEMEN'T' <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 as insurance certificate from my workers' <br />compensation +*+??*?+*+ce can-ier certifying that I carry such insurance and that the policy shall not be <br />canceled nor the covera aced except upon thirty (30) days prior written notice to the City of Santa <br />_. .: .Ana <br />?..:; _. <br />Title i7???'rl...? ?-? _ <br />_, _/ , <br />Firm /?/?ikoL.? ?i?/c?e lLa?rT'oN <br />Date ?_ ?. O/ c, <br />TO BE INCLUDED IN BID PACKAGE <br />BP 1O of 31