Laserfiche WebLink
Last Revised: 5-22-24 Page 6 Agreement <br />WPCP Sludge-Soil-Cement Stabilization and Fill Project No. 2025.6020 <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 /> <br />Docusign Envelope ID: F22D94EC-CD2A-4D08-AF55-EDF1D641560E <br />Mary Coombe <br />July 18, 2025 | 4:48:13 PM EDT <br />251-5500916 <br />2901 Douglas Blvd., Ste 300, Roseville, CA 95661