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CITY OF SANTA ANA <br />PROJECT 06 -1723: FIRST STREET BRIDGE REPLACEMENT PROJECT <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 co�ninencing the performance of <br />the work ofthis 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 employees) 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 />Signed � <br />Michae�3- Powell <br />Title President <br />Firm Powell Constructors, Inc <br />Date 03 / 17 / 1 1 <br />BP 11 of 29 <br />