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Last Revised: 12/20/2022 Page 39 Agreement <br />Curb Ramp Upgrades for Annual Street Seal 2021-23 Project No. 2022.0070 <br /> <br /> <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 against <br />liability for worker’s compensation or to undertake self-insurance in accordance with the provisions of that code, and <br />I will comply with such provisions before commencing the performance of the work of 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 />4558 Contractors Place <br /> <br />Livermore, CA, 94551 <br /> <br /> <br /> <br /> <br /> <br /> <br />Business Phone: (925) 443-4200, FAX: (925) 443-6800 <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: 3A8E355E-C488-450F-A4A9-F533B3393C8E <br />John Sposeto <br />July 26, 2023 | 2:54:40 PM EDT