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E. Verification of Coverage <br />Consultant shall furnish CITY with certificates of insurance and with original <br />endorsements affecting coverage required by this AGREEMENT. The certificates and <br />endorsements for each insurance policy are to be signed by a person authorized by that <br />insurer to bind coverage on its behalf. <br />Proof of insurance shall mailed to the following address or any subsequent address as may <br />be directed in writing by the Risk Manager: <br />Risk Manager <br />1017 Middlefield Road <br />Redwood City, CA 94063 <br />F. Subcontractors <br />Consultant shall include all subcontractors as insured under its policies or shall obtain <br />separate certificates and endorsements for each subcontractor. <br />WORKERS' COMPENSATION WAIVER <br />IF CONSULTANT/ CONTRACTOR DOES NOT HAVE ANY EMPLOYEES AND DOES <br />NOT WISH TO COVER THEMSELVES FOR WORKERS' COMPENSATION, THE <br />CONSULTANT/ CONTRACTOR SHALL SIGN THE FOLLOWING STATEMENT, AS WELL <br />AS THE CONTRACT ITSELF, TO EFFECT A FULLY INITIATED CONTRACT: <br />I, AS DESIGNATED CONSULTANT/ CONTRACTOR, DO NOT HAVE, NOR INTEND TO <br />HAVE, FOR THE FULL TERM OF THIS CONTRACT ANY EMPLOYEES. FURTHERMORE, <br />I DO NOT WISH TO OBTAIN OR BE COVERED UNDER ANY WORKERS' <br />COMPENSATION INSURANCE COVERAGE; AND, THEREFORE, AM SIGNING THIS <br />WAIVER IN LIEU OF PROVIDING WORKERS' COMPENSATION, AS OUTLINED IN THE <br />IN URANC(E REQUIREMENTS OF THE CONTRACT. <br />Si ature Date <br />Prin\ted Name ( / I - <br />1�Kar1-� l��r0l ca �I �WL0,�Y <br />Business Nam <br />ATN/AGR/2017.137/KORADE HEARING OFFICER AGREEMENT <br />REV: 06-23-17 RL <br />Page 7 of 11 <br />