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Do cuSig n Envelope ID : C DAEDABD-SAB E-4427-8 13E-4AC4676B066B <br />WORKERS' COMPENSATION INSURANCE CERTIFI CATION <br />Pursuant to Section 7-4 of the Standard Specifications, the Contractor certifies as follows: <br />I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured <br />against liability for worker's compensation or to undertake self-insurance in accordance with the provisions <br />of that code, and I will comply with such provisions before commencing the performance of the work of <br />this contract. <br />s;gned: ~~ D•te: .JLL\t\ ].2D2!) <br />B\t\\e ~~eto ) \)("es,oea~ <br />Business Address (Street Address, City, State & Zip Code): <br />FBD Vanguard Construction , Inc. <br />550 Greenville Road <br />Live1more, CA 94550 <br />Business Phone: (925) 245-1300 <br />Last Revised : 06/01/ 16 Page 7 <br />2019-20 Seal -Curb Ramp Upgrade Ph ase <br />Agreement <br />Project No . 2020.0070