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SHOFAR LLC <br />56655 GraIliWer Ave., IlNew i iudsoo� IlA i 48165 <br />248 227 2306 . ... . . . . . . . . . <br />City of San nta Ai na <br />ilisk IlAao nagerineo 0: IC ivisio <br />20 Civic Center Illllaza <br />San nta Ai na, CA 92702 <br />3 3 <br />iZe Wciirker�3 <br />i ilaJi n ilice / 91 uofar i i C f,,s,,o,, Sunni Vdlage i ereby affirrini u� der peo ahy of peojury tli ne fidHowh q <br />deciaratio� � <br />i cediffy cin IbeN,ulff cif 131clifair i i C f S ail 1311ull Vd[; ge th,; t dix,hig the tern"ii cif umy contract ft:iir 13i,xim Vd[; ge'� <br />i pv Ifilerforrinau ce for tli ae City of Santa Ai na, i wdl onot erinq-Joy ao y per soo� ii a auy rina� no ner so as t Il rine <br />3 <br />subject tcii the wcirkers' :iws' uid' �::flnd ;giree th,;t uf i shciUd beconie eid3ject kii the <br />wciirker's XCII)ASICIns acid SecUcin 3,111( 0 clf the i Bulb slur Ccide, i sh,::dHi ft:iidihwith corinqJy with the <br />provisioo ns aprovide proof of workers corinpe� nsatiouu coverage irinrinediatdy. <br />DatRine 15, 2022 <br />Narin&� 14ilalph.n 14iilice <br />Corinpaq�� 91 nofar i i C f,,s,,o,, Sunni Vdlage <br />dephon&� 248 227 2306 <br />WAIZINPNG� 1: AI UIFUP) (ME11RAGE IS UNI AWI: U I AINI[) SHAI I SUI:3UI:C I AINI[) ()yI:::IZ I () <br />CIUMINAI "IDNAI I NE:c; NIT) CNN 1: NNE:c; U C)INE: I RJINI)IFUD) I I K)USAINI) ICCMI I A6 ($ M0,000), NN A[)[A I C)IN I () I I fl:: (X)SI Cfl: <br />(X)III:�11EDNSA I K)IN, )AIMAGE:c; AS :�"IZCWHAD) 1: ()1Z NN (;I::: C I K)IN 3706 Cfl: I I fl:: I ABOR ( I 0IN IPJ 11 :U,I-;T APJD A � If 0MIJECS :::EES. <br />Risk Muagment DIMsian <br />'SQ REVIEWED & APPROVED BY.- <br />A4+e Aeevaa <br />Hi5k Management Specialist <br />