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MY OF SANTA.ANA <br /> Risk Management a dlvlslon of Human ltesourres <br /> Managing Risk Ihrough Awareness and Action <br /> AI 1DAVIT O FXFMry110N FOR WORKERS' c OMPI-:NSATION INSURANCE <br /> I VAJ__._ )l C— G �'StlYI [ 'lteprl.eohillvu, {,atre;t that l Fltn au aalhorared <br /> w__..._ . __._...�._. <br /> f�,t;�� ul,itlr t lfrft,3.x rir{�r�rwaq,c, / /� <br /> i' h l`�'.1�I 171r f`„IIYr-Lfl) ai.kllit'.I <br /> lxtsuetiti the authorat} to Iegalh.hind Contl-Kim <br /> In m% capak;tty as hepra�c:utatne n1'C urnlaArlt�, I tel�re;ettt and aoitlinn tilt;finksv inf;,trw relates,of the <br /> attrcetuent IVIvxcV1l Cotttpain rtrtaf('it} of 5attita Aail.,;iViacineii((number <br /> ("Allteeutr;nt")to pr°vicle _ ( ,�� C�Lt_S - {,� - —('Services'} <br /> tticn f:cs C.t he Iv:n tiled�uf�t,•,;tFtf cr.tfkcnl'c�gfCracr i <br /> During the course rutd scope of compauy's agreement tt itlt the Cit} ol'Sonta Aria,Conipariv will <br /> trot eratltlo} apt} person in uaay ananncr so as to hecoaue subject-to the vt�orkcrs' coanlxaasation Intt s <br /> ol'Califontia,ratd agrea that it'('onapanr Should becolile Subject to tl{e ttorkcrs' corultcrisation <br /> provisions of`Section 3700 of tits!.,tenor•Code,C'oauptnty sltall forthwith comply witch the <br /> pmviniorta tend provide proof of ttarkerx'coaupellstatioat covetoge inttnediatel} <br /> If at any time it is found that Company is not adh4riug to any andAw all of(he statements in this <br /> doc:t►niant.and does not tuainlain the tninimurn"otkers'conipensaition insurance coverage as <br /> required in the.Agreement,it tt ifl be ccttasidered a breach orAgreemeri(rendering the Agreement <br /> null and void and C;ontlmny tt ili be fully liable For an} arid all d4unage.s. <br /> ti <br /> Sf�r!'�IU1't rya[d <br /> r3r,f,i?��11F0 <br /> F.'nfua.F h,ErnfnF�fefn.,Le, fed lfc\uu,lrk•r aeut fE3 Ld&,.r <br /> WARNING: FiXII.t'It.F.'l[)SECURE.4C'ORKL•'ItS'COMPt:NSATION CO1 f:'ft_ GE IS UNLAWFUL, <br /> ,AND SHAI..I.St~`BJ1-,CT AN I NIPLOYI:'R TO CRIXIINAL PEN ll,1' E S AND CIVIL FIN VS UP TO <br /> fN.tI)DITION. t'()THj C0M,()F <br /> COMPE'NS TION,DAXIA[IES AS PROVIDED FOR IN SECTION 370(1 OI:4111.'LABOR C( DF. <br /> 1N`II:ItI S't',.1�I).1'I1'QIttiI }"S FEES. <br /> AEfdavltofExempWn for Workers fompecsaanInsurance tt.12 202.3 <br />