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9 <br />Labor Code Compliance Acknowledgement <br />Applicant hereby acknowledges that he/she is aware of and agree$ to comply with the provisions of Labor Code Section 3700 that �. <br />requires every employer to secure the payment of compensation fin liability under the State's worker compensation low, Applicant <br />hereby submits proof that the payment Of compensation for Ilablldy under the State s worker compensation law has been secured In a <br />lawful manner. <br />Applicant understands and acknowledges that any msreprosentatfdh, falsification, OF material emission on this application or any <br />document submitted In connection herewith Is grounds for denialOf this application or subsequent revocation of registration. <br />Applicant hereby agrees to complete an IRS form 8822, Tax Information Authorization and submit it to the IRS. <br />The undersigned hereby certifies under penalty of perjury that the Statements made and information provided on this application are <br />true and correct and that the applicant is in complete Compliance with local government's business licensing and regional regulatory <br />requirements. <br />ANY MATERIAL MISREPRESENTATION IS GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF A LICENSE/REGISTRATION, <br />Labor Code Compliance Acknowledgement <br />I Acknowledge Labor CodeCompliance: Yes -.„._.....____....._.._...____._.-...___..__.___....__....„.n.__. <br />Enter Your Name, Donald ESeaman <br />Registration Serincei:- Page 7 of 7 <br />