5-Attachment VI-B - Workers Compensation Insurance (Subcontractor).pdf

This is a Workers Compensation Insurance Certification form required by the City of Buda, Texas, in accordance with Texas Labor Code 406.096. The document serves as a mandatory certification that all subcontractors working on the City Park East Parking Lot project must complete and submit to the City. The project involves the construction of approximately 134 additional parking spaces with an asphalt surface at Buda City Park located at 204 San Antonio Street. The scope of work includes grading and drainage, importing borrow fill material, sub-grade preparation, flexible base, asphalt installation with curb and gutter, landscaping, revegetation of disturbed areas, signage, and striping.

The certification requires subcontractors to verify in writing that they maintain workers compensation insurance coverage for all personnel involved in the project. Contractors must submit one completed certification form for each subcontractor participating in the work. The form requires the subcontractor name, authorized representative signature, and date of certification. This requirement ensures compliance with state labor law and protects workers engaged in the parking lot construction project.