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Addendum No. 1 3uly 9. 2009 <br />Workers' Compensation Insurance Certification <br />As required by California Labor Code Section 1860 and 1861, the Contractor certifies as follows: <br />I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer <br />to be insured against liability for worker's compensation or to undertake self - insurance in <br />accordance with the provisions of the Code. and I will comply with such provisions before <br />commencing the performance of the work of this contract. <br />If 1, as the Contractor, now or at any time during the course of this agreement, qualify as an <br />employer under California Labor Code Section 3300, unless the hired employee(s) is (are) <br />persons excluded by said Labor Code, 1 shall furnish the City of Santa Ana with an insurance <br />certificate from my workers' compensation insurance carrier certifying that I carry such insurance <br />and that the policy shall not be canceled nor the coverage reduced except upon thirty (30) days <br />prior written notice to the City of Santa Ana. <br />Signed <br />TitleLiF,�" <br />Firm r CD CI 1� ?LNG EN�)t NFEl2! nlE� AND MAa,t1`IF/vA/JCF_ tNG <br />Date .1(/L`/ IS ZOD`j <br />Page I1 of 16 <br />