Contractor's_Certificate_Regarding_Workers'_Compensation.pdf
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- Solicitation number
- 26-037
- Issued by
- Alameda County, Hayward City, California
About this file
This is a Contractor's Certificate Regarding Workers' Compensation form required by the City of Hayward, California for the Construction Management Consulting Services for Airport Improvement Program (AIP) Projects at Hayward Executive Airport (RFQual 26-037). The certificate must be completed, executed, and submitted with the bid form prior to performing any work under the contract. Respondents must demonstrate compliance with California Labor Code Section 3700, which requires every employer to secure worker's compensation insurance through authorization from the Director of Industrial Relations or undertake self-insurance in accordance with state code provisions. The sealed Statements of Qualifications and bids are due by 4:00 PM on Tuesday, April 7, 2026, submitted electronically through the City's eProcurement Portal, with a deadline for questions by March 24, 2026. The scope encompasses full-time construction observation and inspection services for Taxiway Zulu and Taxiway Alpha 1 Reconstruction, including daily construction observation for day and night shifts, materials testing, survey services, construction contract administration, and comprehensive documentation. Monthly progress meetings are required with at least one in-person monthly attendance, plus additional in-person attendance for pre-construction conferences, pre-pave workshops, and inspections, with anticipated monthly site visits of approximately six hours duration.
Respondents must maintain Workers' Compensation and Employer's Liability Insurance with public liability coverage of not less than $1,000,000 per occurrence and comply with prevailing wage requirements under California Labor Code Sections 1771 and 1777.5. The incumbent construction contractor is DeSilva Gates Construction, awarded the construction contract on May 27, 2025, with contract execution anticipated by April 1, 2026. The underlying construction project has an Engineer's estimated cost of $1,850,670 for Base Bid work, funded through a combination of Federal Aviation Administration (FAA) grants, California Department of Transportation (Caltrans) funds, and Airport revenue. Disadvantaged Business Enterprise (DBE) participation is required in accordance with 49 CFR Part 26. Pricing will be negotiated following selection on a not-to-exceed basis. Respondents must submit certified payroll records within ten days of City request and include required forms with submissions: Designation of Subcontractors, Non-Collusion Affidavit, Contractor's Certificate Regarding Workers' Compensation, Respondent's Reference and Statement of Experience, Non-Nuclear Affirmation, and Nondiscriminatory Affirmative Action Certification.
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Text version
*THIS DOCUMENT MUST BE COMPLETED, EXECUTED AND SUBMITTED WITH THE BID FORM*
CONTRACTOR’S CERTIFICATE
REGARDING WORKER’S COMPENSATION
LABOR CODE SECTION 3700
“Every employer except the State and all political subdivisions or institutions thereof, shall secure the payment of compensation in one or more of the following ways:
(a) By being insured against liability to pay compensation in one or more insurers duly authorized to write compensation insurance in this State.
(b) By securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given upon furnishing proof satisfactory to the City of Industrial Relations of ability to self-insure and to pay any compensation that may become due to this employees.’
I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker’s 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 this contract.
SIGNATURE: ______________________________
Print Name: ______________________________
Date: ______________________________
(In accordance with Article 5 [commencing at Section 1860], Chapter I, Part 7, Division 2 of the Labor Code, the above certificate must signed and filed with the awarding body prior to performing any work under this contract.)
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