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i <br />11-0-6—W-bLv�4'Q6 hereby affirm under penalty of pejury, the <br />following fi <br />I certify on behalf of /y +that during the term ofmy <br />contract for} R itservices with the Cityof Santa9 <br />not employ any person in any manner so as to become subject to the workers' <br />compensation laws of California, and agree that if 1 should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: <br />Ey, u <br />Name: 10 <br />Title;r c � <br />Telephone: <br />�edby' <br />a G PV`lr <br />