Laserfiche WebLink
N=2018;170 <br />WORKEi2S' COMPENSATION DECLARA`'ON <br />hereby affirm under penalty of }perjury, the <br />(Nameii'NIe1 <br />following declaration: <br />1 certify on behalf of t,! Q�a �V Q kl that during the tern of my <br />,nsulianUCbm tame) <br />contract for � �',. �� services with the City of Santa Ana, l will <br />not employ an), person in any manner so as to become subject to the workers' <br />compensation laws of California, and agree that if I should become subject to the <br />workmr compensation provisions of Section 3700 of the Labor Code, i sliall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: W�$ <br />w... .. �A <br />