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<br /> <br /> <br /> 0 • <br /> CITY OF SANTA ANA <br /> <br /> . PROJECT NOS. 06-1500, 07-3206, AND 09-3521 <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 <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 /> <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 employee(s) is (are) persons <br /> excluded by said Labor Code, I shall furnish the City of Santa Ana with an insurance certificate <br /> from my workers' compensation insurance carrier certifying that I carry such insurance and that the <br /> policy shall not be canceled nor the coverage reduced except upon thirty (30) days prior written <br /> notice to the City of Santa Ana. <br /> <br /> Signed <br /> _ <br /> olc~+ B~~ a ~1 <br /> Title Q~~°~z°?11- <br /> Firm~1 (-~i'YY?~ (?1e?1 <br /> <br /> <br /> Date <br /> C~r~ h a <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP 15 of 21 <br />