3-00 45 26 Contractor Compliance with Workers Compensation Law.doc
DOC document 64 KB Posted
- Solicitation number
- 25-0254
- Issued by
- Tarrant County, Texas
About this file
This document is a Contractor Compliance with Worker's Compensation Law certification for the City of Fort Worth's 2026 Asphalt Resurfacing Contract (City Project No. 106136) located in Texas. The project involves comprehensive roadway rehabilitation and reconstruction, including approximately 21,688 square yards of 11" pavement pulverization, 28,712 square yards of 12" pavement pulverization, 32,388 square yards of 2" Asphalt Pavement Superpave SP-D, 3,676 square yards of surface milling, 807 tons of cement-lime treatment, 1,851 linear feet of concrete curb and gutter replacement, 1,320 square feet of concrete driveway replacement, 9 ADA curb ramp replacements, and 22,400 linear feet of pavement marking.
The document specifically requires the contractor to certify that they provide worker's compensation insurance coverage for all employees working on the project, and they must also obtain and submit worker's compensation compliance certificates from all subcontractors. While the document does not explicitly detail pricing or funding sources, it is part of a municipal infrastructure improvement project that appears to be funded through the City of Fort Worth's public works budget. The certification form requires notarization and includes space for the contractor's company details, signature, and official acknowledgment.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 8-City Project No. 106136.xlsx | XLSX spreadsheet | |
| 5-00 11 13 Invitation to Bidders.docx | DOCX document | |
| 9-Submission Instructions - 25-0254.docx | DOCX document | |
| 7-106136 Project Manual.pdf | ||
| 2-Bid Documents Package Folder Contents Checklist.doc | DOC document | |
| 6-Small Business Utilization Form.pdf | ||
| 4-00 45 11 Bidders Prequalifications.doc | DOC document | |
| 1-00 45 13 Prequalification Application.docx | DOCX 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. 106136. 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
2026 ASPHALT RESURFACING CONTRACT 2
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS
City Project No. 106136 Revised July 1, 2011
File details come from the government source that posted it. Updated .