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Last Revised: 5-22-24 Page 37 Agreement <br />PWSC Replace Fuel Tanks Project No. 2020.3600 <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 <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 /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Business Phone: ( ) <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: ECEBC404-BFCA-4221-8588-047D31BC0669 <br />2600 Williams Street <br />94577 <br />San Leandro, CA <br />Brett Norman <br />9256719200 <br />May 5, 2025 | 11:59:45 AM PDT