ATTACHMENT 12- WORKERS_ COMPENSATION CERTIFICATION.pdf
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- Solicitation number
- 0000039767
- Issued by
- California
About this file
This is a Workers' Compensation Certification form required as Attachment 12 to a state contract opportunity, likely governed by California state requirements. The form mandates that bidders complete and submit the certification with their proposal to demonstrate compliance with California Labor Code Section 3700. Bidders must certify their awareness of provisions requiring every employer to maintain workers' compensation insurance or undertake self-insurance prior to commencing work on the contract. The form requires completion by the bidder's authorized representative or corporate officer, with fields for the firm name, printed name of the authorized representative, title/role, signature, and date.
The certification serves as a compliance verification document with no specific pricing, quantities, timelines, or contract terms detailed within the form itself. This attachment is a mandatory submission requirement for all bidders participating in the contract opportunity and represents a prerequisite for proposal acceptance rather than a standalone deliverable.
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ATTACHMENT 12: WORKERS' COMPENSATION CERTIFICATION
WORKERS' COMPENSATION CERTIFICATION
The Bidder must complete and submit this form with its proposal.
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 require 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.
The Bidder's Authorized Representative or Corporate Officer:
Bidder/Firm Name:
Printed Name of Authorized Representative:
Title/Role:
Signature:
Date:
| ATTACHMENT 12: WORKERS' COMPENSATION CERTIFICATION |
| WORKERS' COMPENSATION CERTIFICATION |
File details come from the government source that posted it. Updated .