W_C Exemption.pdf
PDF 106 KB Posted
- Attached to
- Conference Room Audio-Visual Equipment Upgrade
- Solicitation number
- RFP_F-Contr-0000000109
- Issued by
- Contra Costa County, California
About this file
This document is a Workers' Compensation Exemption certification form for a contract that requires the contractor to verify their employee status and workers' compensation insurance compliance with California state law. The form specifically addresses situations where a business has no employees other than owners, officers, directors, partners, or principals who have elected to be exempt from Workers' Compensation coverage.
The certification requires the contractor to acknowledge California Labor Code Section 3700, which mandates that employers with one or more employees must be insured against workers' compensation liability or undertake self-insurance. If the contractor subsequently hires employees during the contract period, they are obligated to immediately cease work, obtain a Workers' Compensation Insurance Certificate, and submit it to the County. The form provides space for the contractor's signature, printed name, initials, and date of signing, indicating it is a legally binding document to be executed by the contracting party.
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Other files
| File | Type | Posted |
|---|---|---|
| Contract Terms and Conditions Rev 2014.docx | DOCX document | |
| RFP_F-Contr-00000000109 - AV Update - ATTACHMENT D.pdf | ||
| RFP_F-Contr-00000000109 - AV Update - final to post.docx | DOCX document | |
| SBE - Registration Cert Form.doc | DOC document |
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Text version
Workers’ Compensation Exemption – Certifying No Employees.
With respect to the Contractor’s services to this contract, the business has no employees other than the owners, officers, directors, partners or other principals who have elected to be exempt from Workers’ Compensation coverage in accordance with California law. Contractor is aware of the provisions of California Labor Code Section 3700, which requires every employer having one or more employees to be insured against liability for workers’ compensation or to undertake self‐insurance in accordance with the provisions of that code.
Contractor understands that if while performing the work identified herein, employs someone to become subject to the Workers Compensation Laws of California, the claim of exemption executed under this paragraph will no longer be valid. Contractor further affirm that if subject to the Workers' Compensation Laws of California while performing the work under this Contract, will immediately cease work and obtain a Certificate of Workers’ Compensation Insurance, submit that Certificate to the County immediately following its effective date, and at all times when performing services under this Contract maintain the coverage provided by the Certificate in accordance with the law.
Contractor Signed:_______________ Initials:
Printed:________________________ Date:
File details come from the government source that posted it. Updated .