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FABIO ACOSTA
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Last modified
7/11/2012 11:29:24 AM
Creation date
6/29/2012 4:03:31 PM
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General - Type
Agendas
General 2 - Date
6/29/2012
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Fab"Io Acosta <br />1, l=abia Acosta hereby, certify and acknowledge that I am aware of the <br />Workers Compensation laws of the State of California and that I have no <br />employees which would be subject to the protection of the Workers <br />Compensation Act at this time. And that if any time during the term of the <br />Agreement, any employee are obtained, that I will comply with the <br />requirement of the Workers Compensation laws and will provide evidence <br />of such coverage to the City of Riverside in accordance with the terms of <br />the Agreement.. I <br />a <br />By: Date: <br />Title: ater Auditor <br />APPROV $ TO FORM <br />I' P I <br />Risk Manager <br />
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