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Mulford Marina Branch Library <br />COSL Project No. 2018.2400 <br /> <br /> <br />June 17, 2025 00 30 00 - 6 <br /> <br /> <br /> <br />WORKERS’ COMPENSATION INSURANCE CERTIFICATION <br /> <br /> <br />Pursuant to Section 00 72 00-7-3, 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 />Docusign Envelope ID: 6E077573-9E17-4E49-85C2-F081174AB97C <br />(510) 972 8750 <br />July 1, 2025 | 9:33:31 AM PDT <br />6689 Skyline Blvd. <br />94611 <br />Daniel Wood <br />Oakland, CA