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FULL PACKET_2019-10-01
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FULL PACKET_2019-10-01
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9/30/2019 9:46:55 AM
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9/30/2019 8:45:03 AM
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City Clerk
Doc Type
Agenda Packet
Agency
Clerk of the Council
Date
10/1/2019
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EXHIBIT 1 <br />Prison to Employment ImplementationDirect <br />Form 5: Workers' Compensation Certification EDD RFA ,0.9 <br />I am aware of the provisions of section 3700 of the California Labor Code which requires every <br />employer to be insured against liability for workers' compensation or to undertake self- <br />insurance in accordance with such provisions before commencing the performance of the work <br />of this Agreement. <br />Samantha M. Lambert Risk Management Sup' <br />Name and Title (Print or Type) <br />City of Santa Ana <br />Firm Name <br />14-Feb-19 <br />Date <br />20 Civic Center Plaza <br />Street Address <br />Santa Ana, GA 92702 <br />City, State, Zip <br />25A-36 <br />
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