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PROJ; NO, 136784, 126776 <br />ADDENDUM NO. TWO <br />CITY OF SANTA ANA <br />PROJECT' NO, 13 -67 84, 12 -6776 MCFADDEN REHABILITATION WEST CITY LIMIT TO <br />NEWHOPE <br />PROPOSAL AND CONTRACT AGRLLLMENT <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 commencing the performance of <br />the work of this contract. <br />If I, as the Conti-actor, now or at any time during the course of this agreement, qualify as an employer <br />wider California Labor Code Section 3300, unless the hired employees) is (are) persons excluded by <br />said Labor Code, T shall furnish the City of Santa Ana with an insurance certificate from my workers' <br />compensation insuramce 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 />Signec <br />Title <br />Date <br />BP 10 of 16 <br />