COMPENSATION CERTIFICATION. Labor Code section 3700 in relevant part provides: Every employer except the State shall secure the payment of compensation in one or more of the following ways: ▪ By being insured against liability to pay compensation by one or more insurers duly authorized to write compensation insurance in this State. ▪ By securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any compensation that may become due to its employees. Check one box and sign this form: □ I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the Work of this Contract. □ I am exempt from the Workers’ Compensation requirements of Labor Code section 3700. Date: Proper Name of Inspector: Signature: Print Name: Title: (In accordance with Article 5 – commencing at Section 1860, Chapter 1, part 7, Division 2 of the Labor Code, the above certificate must be signed and filed with District prior to performing any Work under this Contract.)
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Samples: www.rowlandschools.org, www.rowlandschools.org, www.rowlandschools.org
COMPENSATION CERTIFICATION. Labor Code section 3700 in relevant part provides: Every employer except the State shall secure the payment of compensation in one or more of the following ways: ▪ By being insured against liability to pay compensation by one or more insurers duly authorized to write compensation insurance in this State. ▪ By securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any compensation that may become due to its employees. Check one box and sign this form: □ I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ ' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the Work of this Contract. □ I am exempt from the Workers’ ' Compensation requirements of Labor Code section 3700. Date: Proper Name of Inspector: Signature: Print Name: Title: (In accordance with Article 5 – commencing at Section 1860, Chapter 1, part 7, Division 2 of the Labor Code, the above certificate must be signed and filed with District prior to performing any Work under this Contract.)
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Samples: www.rowlandschools.org