Attachment_12_-_Workers_Comp_Certification_Public_Works.docx
DOCX document 18 KB Posted
- Attached to
- RFP 23-21 On-site Scanning and Imaging Services
- Solicitation number
- 0000031328
- Issued by
- California
About this file
This document is a Workers' Compensation Certification for RFP 23-21 On-site Scanning and Imaging Services in the state of California. The certification requires the bidder to acknowledge that they are aware of the workers' compensation provisions in the California Labor Code and will comply with such provisions before commencing work on the contract. The bidder must provide their legal company name, federal ID number, signature, printed name and title, and the county and state where the document is executed.
The related state and local contract opportunity is for RFP 23-21 On-site Scanning and Imaging Services, which is located in the state of California. No other details about the contract opportunity are provided in the given information.
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Text version
RFP 23-21 On-site Scanning and Imaging Services
ATTACHMENT 12WORKERS’ COMPENSATION certification
Pursuant to Labor Code Section 3700, 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.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the Bidder to this certification. This certification is made under the laws of the State of California.
| Legal Name of Company (Printed): |
| Federal ID Number: |
| Signature: |
| Date Executed: |
Printed Name and Title of Person Signing:
| Executed in the County of: |
| In the State of: |
Rev. 2020-07 Page 1 of 1
File details come from the government source that posted it. Updated .