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<br />Ftug: ,'().3 04 04: 0410 <br /> <br />T11ae;1 <br /> <br />10.3 <br /> <br />Dale: <br /> <br />? /dQ/4'Y£ <br /> <br />I, <br /> <br />affirm under penalty, the following declaration: <br /> <br />I certify that during the tenn of this contract with the City of Santa Ana, I will not <br />employ any person in any maImer so as to become subject to worker's compensation laws <br />of the Sate of California. And agree that ifI should become subject to the worker's <br />compensation provisions of Section 3700 of the Labor Code, I shall forthwith so comply <br />with those provisions. <br /> <br />Signed: ce~ Jì~ <br />Clovis Glenn <br />C.B. Glenn Tile Company <br /> <br />.r: 1/~ Lv <br />r 11 ( (;-Iel\f\' <br />t.ß. ')lP <br />-?.."- I <br />'ÎOO J <br />N'I' <br /> <br /> <br />~ <br />