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10 March 2026 Page 5 of 8 Agreement <br />Small TCD Installations Project No. 2017.0540 <br />WORKERS’ COMPENSATION INSURANCE CERTIFICATION <br />Pursuant to Section 5-4.3 of the Standard Specifications, the Contractor certifies as follows: <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 />Signed: Date: <br />(Typed or Printed Name) <br />Business Address (Street Address, City, State & Zip Code): <br />Business Phone: ( ) <br />Docusign Envelope ID: 66BE2211-F1D8-4A58-A21D-7D3612189AF0 <br /> San Leandro, CA 94577 <br />510-575-2547 <br />Alex Peña <br />March 27, 2026 | 4:14:22 PM PDT <br />207 Oakes blvd.