Attachment_10_-_Workers__Compensation_Certification.pdf
PDF 53 KB Posted
- Attached to
- RFP-24-001: California Native American and Indigenous Artists Grant Program Design and Guidelines
- Solicitation number
- 0000033530
About this file
This is a Workers' Compensation Certification form that appears to be an attachment to a California state or local government RFP (Request for Proposal). The document requires bidders to certify their awareness of Section 3700 of the California Labor Code, which mandates that employers must have workers' compensation insurance or self-insurance before beginning contract work.
The form requires the bidder to provide their signature, date, name and title (printed or typed), firm name, and complete business address including street, city, state, and ZIP code. The document includes fields for an RFP number and attachment number at the top of the form, suggesting it is part of a larger proposal package.
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Text version
WORKERS’ COMPENSATIONCERTIFICATION
The undersigned in submitting this document hereby certifies the following:
I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with such provisions before commencing the performance of the work of this contract.
Signature Date
Name and Title (Print or Type)
Firm Name
Street Address City State ZIP
RFP No.: _______________
Attachment _______:
| RFP No: RFP-24-001 |
| undefined: 10 |
| Date: |
| Name and Title Print or Type: |
| Firm Name: |
| Street Address: |
| City: |
| State: |
| ZIP: |
File details come from the government source that posted it. Updated .