______________________________________________ (“Contractor”)
ADDENDUM RE LABOR CODE COMPLIANCE

__________________________________________________ (“Client”)

Contract Dated: __________________________, 200_

COMPLIANCE WITH

CALIFORNIA LABOR CODE SECTION 2810

Contractor hereby provides the following information in relation to the above referenced contract so as to comply with California Labor Code Section 2810:

Contractor hereby represents and warrants that the Contract Sum is sufficient to allow Contractor to comply with all applicable local, state and federal laws or regulations governing the labor or services to be provided under the Agreement. Contractor warrants that the information set forth in this Exhibit is accurate. Contractor agrees that if any of the information provided in Items 7 or 9 herein is an estimate, then Contractor shall provide Owner with updated information as it becomes known to Contractor.

1. The name, address and telephone number of the person or entity (“Contractor”) through whom the labor or services are to be provided:

Name: _______________________________ Phone: ____________________________
Address: ________________________________________________________________

2. A description of the labor service to be provided and a statement of when those services start and are to be completed, if not fully described in the contract. _________________________
________________________________________________________________________

3. Contractor's employer's identification number: __________________________________

4. Contractor's worker's compensation insurance carrier information:

Name of Carrier: __________________________________________________________

Phone Number: ___________________________________________________________

Insurance Policy Number: ___________________________________________________

Address: _______________________________________________________

5. The vehicle identification number of any vehicle that is owned by the contractor and used for transportation in connection with the services to be provided: ____________________
________________________________________________________________________

The vehicle liability insurance policy number covering the vehicle:
_______________________________________________________________________

The name, address, and telephone numbers of the vehicles insurance carrier:

Name of the Carrier: _____________________________________________________
Phone Number: __________________________________________________________
Address: _______________________________________________________________

6. The address of any real property where any workers will be housed in connection with the contract, or “N/A” if not applicable to this contract: ______________________________

7. The total number of workers to be employed under the contract, and the total amount of all wages to be paid, and days or dates wages, are to be paid:

Number of workers: ________________________________________________________

Total Amount of Wages: ____________________________________________________

Day / Dates Wages Paid: _____________________________________________________

8. The amount of commission or other payments made to the contractor for services under the contract: $_______________

9. The total number of persons who will be utilized under the contract as independent contractors along with a list of their current local, state and federal contractor's license ID numbers which may be required:

Number of Independent Contractors : _________________________________________

Contractor's or other required License Number(s): _____________________________,
__________________, __________________________, __________________________,
 

Sample Compliance Form Only: Please seek Legal Counsel in creating your specific Compliance Form

The Statute Labor Code 2810