Attachment_7_-_Individual___Sole_Proprietor.pdf

32 KB Posted

Attached to
RFP-25-002: 50th Anniversary Event Producer
Solicitation number
0000036746
Issued by
Sacramento County, Sacramento City, San Francisco City, West Sacramento City, California

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Written by GovTribe AI ·

This document is an Individual or Sole Proprietorship Exempt from Workers' Compensation Insurance Statement for the State of California. The form requires an individual or sole proprietor to certify under penalty of perjury that they do not employ any persons in a manner that would make them subject to California's Workers' Compensation Laws.

The form obligates the individual to notify the Department of Rehabilitation within 90 days if any changes occur that would subsequently make their business subject to Workers' Compensation laws. The document is designed to be completed for a specific Request for Proposal (RFP), with spaces provided for the RFP number, the individual's printed name, date, and signature. This serves as a formal declaration of the business's current employment status and potential future obligations regarding workers' compensation insurance.

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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

Carla Pareja Cross-Out

Compensation Insurance Statement: 7
RFP No:
Print Name:
Date:
of:
undefined:

File details come from the government source that posted it. Updated .