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CITY OF SANTA ANA <br />PROJECT . NO. 10 -6600: SANTA CLARA AVENUE SEWER AND WATER MAII�T <br />IlVIPROVEMENTS <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 awaze 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 employees) is (aze) persons <br />excluded by said Labor Code, I shall fiunish the City of Santa Ana with an insurance certificate <br />from my workers' compensation insurance carrier certifying that I cazry such insurance and that the <br />policy shall not be cance nor th coverage reduced except. upon thirty (30) days prior. written <br />notice to the City a a_ <br />Signed -- <br />Title P�' S • cJl >°� -� <br />Firm Garcia Juarez Construction Inc. <br />Date _ 1 �� �/ i <br />BP 9 OF 14 <br />