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24 7 PUMPING
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Last modified
4/8/2016 4:20:46 PM
Creation date
12/21/2015 8:30:54 AM
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General
General - Type
Insurance
General 2 - Date
12/21/2015
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I f �V � - -- hereby, certify and acknowledge that I a rn aware of the <br />Workers Compensation laws of the State of California and that I currently have no <br />employees which would be -subject to the protection of the Workers <br />Compensation Act. Further that if at any time during the term of the Agreement, <br />any employees are hired., that I will comply with the requirement of the Workers <br />Compensation laws. At that time I will provide evidence of such coverage to the <br />City lnf accordance with the terms of the Agreement. <br />B Date: <br />1/(Signature) <br />Title: +� <br />Company: <br />4PPROVEr _J <br />
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