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EXHIBIT A — CERTIFICATE OF EXEMPTION AND WAIVER <br />DIRECTIONS: <br />✓ If the Contractor is NOT required under Colorado law to carry workers' compensation <br />insurance and DOES NOT carry it, this exhibit MUST be completed and attached to the <br />Contract. <br />✓ If the Contractor IS required under Colorado law to carry workers' compensation insurance <br />and DOES carry it, this exhibit IS NOT REQUIRED and may be discarded. <br />The Contractor certifies to the City that it is not required to carry workers' compensation <br />insurance under the Colorado Workers' Compensation Act. The Contractor acknowledges that it <br />will be engaging in activities that may expose it to risk of bodily injury. The Contractor affirms that <br />it is physically capable of performing the activities and that all necessary precautions to prevent <br />injury to the Contractor and others will be taken. The Contractor shall not hold the City liable for <br />any injuries that may arise during or resulting from the work performed under the Contract, and the <br />Contractor shall defend, indemnify, and hold harmless the City from all such claims. <br />STATE OF <br />COUNTY OF <br />Contractor <br />By: <br />Title: <br />) ss. <br />The foregoing instrument was acknowledged before me this day of , 20 <br />by <br />(Insert name of individual signing on behalf of the Contractor) <br />SEAL <br />Notary's official signature <br />Commission expiration date <br />8 <br />66 <br />