5-00 45 26 Contractor Compliance with Workers Compensation Law.doc
DOC document 43 KB Posted
- Solicitation number
- 26-0321
- Issued by
- Tarrant County, Texas
About this file
This is a contractor compliance certification document for the City of Fort Worth, Texas, related to City Project No. 104324 (PW 2022 Bond Year 3 Contract 18). The project encompasses approximately 6,500 linear feet of 8-inch water pipe installation by open cut, 2,000 linear feet of 8-inch sewer pipe by open cut, 400 linear feet of 8-inch sewer pipe by methods other than open cut, 6,500 square yards of pulverization and asphalt overlay, 7,000 square yards of concrete pavement, 20,000 square feet of concrete sidewalk, and 21,500 square feet of concrete driveway.
The document requires contractors to certify compliance with Texas Labor Code Section 406.096(a) by confirming they provide worker's compensation insurance coverage for all employees assigned to the project. Contractors must further certify, pursuant to Texas Labor Code Section 406.096(b), that they will provide the City with subcontractors' certificates of compliance regarding worker's compensation coverage. The certification requires the contractor's authorized representative to sign and have the document notarized before a notary public in Tarrant County, Texas, with specific fields provided for company name, address, signature, title, and notarization details.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-104324 Bid Proposal Workbook.xlsx | XLSX spreadsheet | |
| 1-00 45 42 Small Business Utilization Form.xlsx | XLSX spreadsheet | |
| 8-30048 CFW 2022 Yr 3 Contract 18 FINAL 09222026.pdf.pdf | ||
| 7-00 45 13 Prequalification Application.pdf | ||
| 10-104324 Contract 18 Specifications.pdf | ||
| 9-Submission Instructions - 26-0321.docx | DOCX document | |
| 2-00 45 11 Bidders Prequalifications.pdf | ||
| 6-00 11 13 Invitation to Bidders.docx | DOCX document | |
| 4-Bid Documents Package Folder Contents Checklist.pdf |
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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. 104324. 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
2022 Bond Year 3 Contract 18
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS
CPN 104324
Revised July 1, 2011
File details come from the government source that posted it. Updated .