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CITYWIDE STREET LIGHT UPGRADE <br />RFP NO.: 17-075 <br />WORKERS' COMPENSATION INSURANCR CE TIFICNI'ION <br />As required by California Labor Code Section 1861 and 1861, the Contraotor oertiflas as follows: <br />I am aware of the provisions of Section 3700 of the Labor Code, whlob mgoires every employer to be <br />Inswed against liability for worker's compensation or to undertake self-insurance in acoordairce with the <br />provisions of the Code, d I will comply with such provisions before commencing the perfbrmance of <br />the work of this contra <br />M^ <br />Signed; <br />Tit-leiro osal Mans ' <br />Firm. Siemens Indus , I c Intelligent Traffic Systems <br />Date 8/14/2017 <br />Clty of Santa Ana RFP 17-076 <br />Page A4-6 <br />