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CITY OF SANTA ANA <br />PROIFCT08-6019-MCPADDENTRIANGLE HABITAT RESTORATION <br /> <br />WORKERS' WNIPENSATIONMSI?tANCECERTIFICATION <br />As r¢quireA byCaliforniaLaborCode SeGion 1860 and 1861, lheConfracforcettifi¢s asfollows: <br />PROPOSAL AND CONTRACT AGREEM <br />I am aware of the provisions of Section 1100 of the Labor Cade, which requires every employer to <br />be insured against liability for worker's compensation or to undertake self-insurance in accordance <br />with [he provisions of the Code, and I will comply with such provisions before commencing the <br />performanceoftheworkofThiscontract <br />If I, as the CaNractor, now or at any lima during the ceu of this agreement, qualify as an <br />employer under California Labor Code Section 3300, ante [he hired employee(s) is (are) parsons <br />excluded by said Labor Code, I shall fu 'sh the City Santa Ana with en insurance oedifleate <br />from my workers' compensation insur cattier c dying that I espy such insurance and Thaf (he <br />policy shall sot be canceled sox fhe verage aced eaoepf upon Thirty (10) days prior written <br />noficeto IheCity of Santa Ana, <br />Signed <br />Title <br />Firm STL Laodsrape loc. <br />oar ?I?I?u <br />BP90FIS