5. Contractors Certificate Regarding Workers Compensation FILLABLE.pdf

PDF 134 KB Posted

Attached to
Fire Station No. 55 and City Hall Window and Sliding Glass Door Replacement Project
Solicitation number
147430
Issued by
Riverside County, California

About this file

Written by GovTribe AI ·

This is a Contractor's Certificate Regarding Workers' Compensation required for the Fire Station No. 55 and City Hall Window and Sliding Glass Door Replacement Project in California. The certificate serves as a compliance document in which bidders acknowledge their awareness of California Labor Code Section 3700 requirements mandating that every employer maintain workers' compensation insurance or undertake self-insurance. Bidders must sign and date the certificate, confirming their commitment to comply with these provisions before commencing work on the contract. Hard copy bid bonds are due November 12, 2026, by 2:00 PM PST.

The certificate provides fillable fields for the bidder's name, signature, title, and date, with space for a second bidder's information if applicable. This document is a standard prerequisite for contract award and demonstrates the bidder's acknowledgment of state insurance requirements prior to contract performance.

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16 | P a g e

CONTRACTOR’S CERTIFICATE REGARDING WORKERS’ COMPENSATION

I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this Contract.

Name of Bidder

Signature

Name

Title

Dated

Name of Bidder_2:
Name:
Title_2:
Dated:

File details come from the government source that posted it. Updated .