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<br /> <br /> <br /> <br /> CITY OF SANTA ANA <br /> <br /> PROJECT 12-2621 <br /> SANTA ANA ZOO WALKWAY IMPROVEMENTS <br /> <br /> PROPOSAL AND CONTRACT AGREEMENT <br /> <br /> WORKERS' COMPENSATION INSURANCE CERTIFICATION <br /> <br /> <br /> As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: <br /> <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 /> <br /> If 1, 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 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 /> <br /> Signed <br /> <br /> Title \VK 6 ' . F. <br /> <br /> Firm 1 N~ll~ 71"C, <br /> c <br /> Date <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP8of13 <br />