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Last Revised: 06/01/16 Page 9 Agreement <br />Sanitary Sewer Point Repairs 2021 Project No. 2020.0120 <br />WORKERS’ COMPENSATION INSURANCE CERTIFICATION <br /> <br /> <br />Pursuant to Section 7-4 of the Standard Specifications, the Contractor certifies as follows: <br /> <br /> <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 /> <br /> <br />Signed: Date: <br /> <br /> <br /> (Typed or Printed Name) <br /> <br /> <br /> <br />Business Address (Street Address, City, State & Zip Code): <br /> <br />WESTLAND CONTRACTORS, INC. <br /> <br />3100 E. 10th Street, Unit A <br /> <br />Oakland, CA 94601 <br /> <br /> <br /> <br /> <br />Business Phone: (510) 842-3663 <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: FE7F8D79-6B0F-42D1-812E-8070B1B7DE55