8-00 45 26 Contractor Compliance.doc

DOC document 60 KB Posted

Attached to
PW 2026 CDBG Campbell Street Improvement Project, City Project No. 107033
Solicitation number
26-0338
Issued by
Tarrant County, Texas

About this file

This is a contractor compliance document for the City of Fort Worth, Texas, pertaining to the PW 2026 CDBG Campbell Street Improvement Project (City Project No. 107033). The project encompasses approximately 2,500 linear feet of 7-inch curb and gutter, 3,800 square feet of 6-inch concrete driveway, 12,000 square feet of 4-inch concrete sidewalk, 4,700 square yards of 3-inch asphalt pavement (Superpave SP-D), 4,700 square yards of 11-inch pavement pulverization, 76 tons of cemlime, and 18 barrier-free ADA ramps. The document was revised as of July 1, 2011.

The compliance form requires the contractor to certify, under Texas Labor Code Section 406.096(a), that it provides worker's compensation insurance coverage for all employees assigned to the project. Additionally, pursuant to Texas Labor Code Section 406.096(b), the contractor must provide the City with certificates of compliance demonstrating that all subcontractors maintain appropriate worker's compensation coverage. The certification must be notarized before a notary public in Tarrant County, Texas, and submitted as part of the standard construction specification documents required for project bidding and award.

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5-00 21 13 Instruction to Bidders.docx DOCX document
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1-00 41 00 Bid Proposal Workbook.xlsx XLSX spreadsheet
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6-00 45 13 Prequalification Application.doc DOC document
9-00 52 43 Agreement.doc DOC 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. 107033. 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 CDBG Campbell Street Improvement Project

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS

City Project No. 107033

Revised July 1, 2011

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