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CJTY OF SANTA ANA <br />Project No, 14 -6798: 2013 -2014 Omnibus Concrete Replacement Contract <br />PROPOSAL, AND CON'CRAC "f AGRi3EM1W]" <br />WOIZKEIZS' COMI?C'NSA'I'ION [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 he <br />insurecl 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 ofthis contract. <br />If 1, as the Contractor, now or at any time during the course of this agreement, quality as an employer <br />under California Labor Code Section 3300, unless the hired cmployee(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 />Signed <br />Title <br />Pirm <br />Gate n <br />BP I I of 16 <br />skc <br />