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Last Revised: January 2026 Page 7 Agreement <br />Sanitary Sewer Point Repairs 2024-25 and Floresta Boulevard Sanitary Sewer Replacement Project No. 2024.0120 <br /> <br />WORKERS’ COMPENSATION INSURANCE CERTIFICATION <br /> <br /> <br />Pursuant to Section 5-4.3 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: 8769F825-94E9-44D2-9DDF-ECE4FE869A08 <br />1300 Carroll Ave <br />Neil Hunt <br />March 17, 2026 | 2:33:58 PM PDT <br />(415) 822-1791 <br />San Francisco, CA <br />94124