1-00 45 26 Contractor Compliance with Workers Compensation Law.doc
DOC document 43 KB Posted
- Solicitation number
- 26-0022
- Issued by
- Tarrant County, Fort Worth City, Texas
About this file
This document is a Contractor Compliance with Worker's Compensation Law form for the City of Fort Worth's Concrete Pavement Joint & Crack Seal Unit Price Contract (Project No. 106374). The contract involves miscellaneous task orders for pavement rehabilitation, including concrete pavement joint cleaning and sealing, crack repair, spalling repair, and full depth panel replacement in Texas.
The document requires contractors to certify that they provide worker's compensation insurance coverage for all employees and that they will obtain subcontractor certificates of compliance. The form includes a notarized certification section for the contractor to complete, demonstrating legal compliance with Texas Labor Code Section 406.096. While specific pricing, contract duration, and detailed scope are not explicitly outlined in this document, it appears to be a standard compliance form for a municipal infrastructure maintenance project in Fort Worth, Texas.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4-00 11 13 Invitation to Bidders.docx | DOCX document | |
| 3-Concrete Pavement Joint Crack Seal Unit Price Contract.xlsx | XLSX spreadsheet | |
| 6-Submission Instructions - 26-0022 (rev. 103125).docx | DOCX document | |
| 5-CPN106374 Project Manual.pdf | ||
| 2-Bid Documents Package Folder Contents Checklist.doc | DOC document |
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Text version
00 45 26 - 1
CONTRACTOR COMPLIANCE WITH WORKER'S COMPENSATION LAW
SECTION 00 45 26
CONTRACTOR COMPLIANCE WITH WORKER'S COMPENSATION LAW
Pursuant to Texas Labor Code Section 406.096(a), as amended, Contractor certifies that it provides worker’s compensation insurance coverage for all of its employees employed on City Project No. 106374. Contractor further certifies that, pursuant to Texas Labor Code, Section 406.096(b), as amended, it will provide to City its subcontractor’s certificates of compliance with worker’s compensation coverage.
CONTRACTOR:
_____________________________________ By: ___________________________________ Company
(Please Print) _____________________________________ Signature: ______________________________
Address
Title: __________________________________
City/State/Zip
(Please Print)
THE STATE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, on this day personally appeared
___________________________________, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she executed the same as the act and deed of ____________________________________ for the purposes and consideration therein expressed and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this ____________day of
_______________________, 20__.
Notary Public in and for the State of Texas
END OF SECTION
CITY OF FORT WORTH
Concrete Pavement Joint & Crack Seal Unit Price Contract
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS
Revised July 1, 2011
File details come from the government source that posted it. Updated .