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

This is a Workers Compensation Insurance Certification form required by the City of Buda, Texas, pursuant to Texas Labor Code 406.096. The document serves as a mandatory written certification that subcontractors working on the City Park East Parking Lot project must complete and submit to the City of Buda. The project involves the construction of approximately 134 additional asphalt parking spaces at Buda City Park located at 204 San Antonio Street, with scope elements including grading, drainage, fill material importation, sub-grade preparation, flexible base installation, asphalt paving with curb and gutter, landscaping, revegetation, signage, and striping. Contractors must submit one completed certification form for each subcontractor involved in the project.

The certification requires the subcontractor to acknowledge in writing that it understands and certifies compliance with workers compensation insurance requirements applicable to all subcontractors working on the project. The form requires the subcontractor name, signature of an authorized representative, and date of certification. This document does not contain information regarding pricing terms, award dates, contract duration, bidding deadlines, or other contractual specifics; rather, it functions as a compliance documentation requirement that must be fulfilled as part of the bidding and contracting process for this parking lot construction project.