Workers Compensation Certificate.pdf
PDF 251 KB Posted
- Attached to
- Network Hardware E-Rate Year 2027/2028
- Solicitation number
- 146969
- Issued by
- San Diego County, California
About this file
This is a Workers' Compensation Certificate required form for the Chula Vista Elementary School District's Network Hardware E-Rate Year 2027/2028 procurement (Bid No. 26/27-5) in California. Bidders must complete and submit this form as part of their bid package for network hardware services. The contract term runs from July 1, 2027, through September 30, 2028. Key timeline dates include bid advertisement on October 16 and October 23, 2026; the deadline for bidder questions and substitution requests on November 6, 2026, at 4:00 p.m. PST; final addendum posting on November 13, 2026, at 12:00 p.m. PST; bid due date of November 18, 2026, at 10:00 a.m. PST; preliminary notice of intent to award on November 23, 2026, at 4:00 p.m. PST; an anticipated board meeting for contract award on December 16, 2026; and contract delivery requirement from the proposed awardee by December 28, 2026, at 10:00 a.m. PST.
The certificate requires bidders to affirm under penalty of perjury that they either maintain a certificate of consent to self-insure for workers' compensation under California Labor Code Section 3700 or maintain active workers' compensation insurance for the duration of contract performance. Bidders must provide their carrier name and policy number if carrying insurance. The form also requires bidders to certify that they will not employ any person in a manner that would subject them to California workers' compensation laws, and they agree to immediately comply with Labor Code Section 3700 provisions should they become subject to these requirements. Failure to secure workers' compensation coverage is unlawful and subjects employers to criminal penalties, civil fines, compensation costs, damages, interest, and attorney's fees under California Labor Code Section 3706.
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Other files
| File | Type | Posted |
|---|---|---|
| Bid 26-27-5 Network Hardware E-Rate Year 2027 2028.pdf | ||
| References.pdf | ||
| Bid Proposal Form.pdf | ||
| Non-Collusion Affidavit.pdf | ||
| Certification.pdf | ||
| Notice to Bidders.pdf | ||
| Agreement.pdf | ||
| Fingerprint and Criminal Background Check Certification.pdf | ||
| Drug-Free Workplace Certification.pdf | ||
| Certification regarding Debarment.pdf | ||
| Bid Price Sheet.xlsx | XLSX spreadsheet | |
| Affirmative Action Program.pdf | ||
| Transmittal Letter.docx | DOCX document |
Show all 13
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Text version
CHULA VISTA ELEMENTARY SCHOOL DISTRICT
Bid No. 26/27-5 Network Hardware E-Rate Year 2027/2028
Required Form Workers’ Compensation Certificate
I hereby affirm, under penalty of perjury, one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for workers’ compensation, as provided by Labor Code section 3700, for the duration of any business activities conducted for which this contract is issued.
o I have and will maintain workers’ compensation insurance, as required by Labor Code section 3700, for the duration of any business activities conducted for which this contract is issued.
My workers’ compensation insurance and policy number are:
Carrier
Policy Number
I certify that in the performance of any business activities for which this contract is issued, I shall not employ any person in any manner so as to become subject to the workers’ compensation laws of California, and agree that if I should become subject to the workers’ compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions of Labor Code section 3700.
Name: Date:
Address: Signature:
Warning: Failure to secure workers’ compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney’s fees.
File details come from the government source that posted it. Updated .