Attachment_11_-_Individual___Sole_Proprietor.pdf
PDF 30 KB Posted
- Attached to
- RFP-24-001: California Native American and Indigenous Artists Grant Program Design and Guidelines
- Solicitation number
- 0000033530
About this file
This is a Workers' Compensation Insurance exemption form attachment for the California Department of Rehabilitation's RFP. The document serves as a legal certification for individual or sole proprietors to declare they do not employ any persons in a manner that would subject them to California Workers' Compensation Laws.
The form requires the business owner to notify the Department of Rehabilitation within 90 days if any changes occur that would make the business subject to Workers' Compensation laws. The document must be completed with an RFP number, printed name, signature, and date. This appears to be a standard required attachment for qualifying sole proprietors responding to the Department's RFP process.
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Text version
ATTACHMENT ____: Individual or Sole Proprietorship Exempt from Workers’ Compensation Insurance Statement
______ of ______
I certify under penalty of perjury under the laws of the State of California that I do not employ any person in any manner as to become subject to the Workers’ Compensation Laws of California.
I further certify that the Department of Rehabilitation will be notified within ninety (90) days of any changes which results in the business becoming subject to the Workers’ Compensation laws of the State of California.
RFP No.: _____________________
Print Name Date
Signature
| Compensation Insurance Statement: 11 |
| RFP No: RFP-24-001 |
| Print Name: |
| Date: |
| of: |
| undefined: |
File details come from the government source that posted it. Updated .