ATTACHMENT 8- WORKERS_ COMPENSATION CERTIFICATION.pdf

PDF 41 KB Posted

Attached to
Water Technical Access Portal (WaterTAP) 2. 0
Solicitation number
0000040529
Issued by
California

About this file

This is a Workers' Compensation Certification attachment required for submission with a proposal to a California state or local contracting agency. The document mandates that bidders certify their awareness of Section 3700 of the California Labor Code, which requires all employers to maintain workers' compensation insurance coverage or establish self-insurance prior to commencing work on the contract. The certification form requires completion and submission by the bidder's authorized representative or corporate officer, including the bidder's firm name, the printed name and title of the authorized representative, the representative's signature, and the date of certification.

No pricing information, set-asides, incumbency details, funding sources, or other contract terms are specified in this certification attachment. The document serves solely as a compliance verification mechanism to ensure bidders acknowledge their statutory obligation to maintain appropriate workers' compensation coverage under California law before performing any contract work.

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ATTACHMENT 8: WORKERS' COMPENSATION CERTIFICATION

ATTACHMENT 8: 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 8: WORKERS' COMPENSATION CERTIFICATION
ATTACHMENT 8: WORKERS' COMPENSATION CERTIFICATION

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