Attachment_8_-_Workers__Compensation_Certification.pdf
PDF 71 KB Posted
- Attached to
- RFP-25-004 Publicist for CAC's 50th Anniversary
- Solicitation number
- 0000037159
- Issued by
- Sacramento County, Sacramento City, West Sacramento City, California
About this file
This is a Workers' Compensation Certification form required for state and local contract submissions in California. The document serves as Attachment 8 to a Request for Proposal (RFP) and certifies that the submitting employer is aware of and compliant with Section 3700 of the California Labor Code. The certification requires employers to maintain workers' compensation insurance coverage or approved self-insurance before commencing work on the contract.
The form requires the bidder to provide signature, date, printed name and title, firm name, and complete street address including city, state, and ZIP code. This certification must be completed and submitted as part of the proposal package, with the RFP number referenced on the document. The form serves as a prerequisite compliance document ensuring that only insured or self-insured employers may bid on the contract opportunity.
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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: |
| undefined: 8 |
| Date: |
| Name and Title Print or Type: |
| Firm Name: |
| Street Address: |
| City: |
| State: |
| ZIP: |
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