Laserfiche WebLink
PAGE 01 <br /> <br />~OKKERS' cOMPENSATION DECLARATION <br /> <br />following declaration: <br /> <br /> I cvrli~ on behalf of ?'R M t ~' / ~,~', ~ u ~p ff that d~ m~ t~ of my <br />~n~aet~e C t~ ~_s t~O~t~. ,CityofSanm~l~llnot <br /> <br />employ ~y p~n in my manner ~ ~q to become subj~t to the worke~' ~mpenmfion <br /> <br />laws of Califomi~ and agrcc lhat if I should b~;ome subject to the workers' <br /> <br />compensation provisions of Section 3700 of the Labor Code, 1 shall forthwRh comply <br /> <br />w~th those provisions. <br /> <br />Title: _ <br /> <br />Telcphon~: <br /> <br />WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />AND CIVIL FINES UP TO ONE IIUNDRED THOUSAND DOLLARS ($100,000), IN <br />ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />IN SECT10~13706 OF THE LA,BOR CODE, INTEREST, AND ATTOP. lqEY'S FEES. <br /> <br /> <br />