Attachment_7_-_Individual___Sole_Proprietor.pdf

32 KB Posted

Attached to
RFP-25-004 Publicist for CAC's 50th Anniversary
Solicitation number
0000037159
Issued by
Sacramento County, Sacramento City, West Sacramento City, California

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Written by GovTribe AI ·

This is an attestation form for individuals or sole proprietors seeking an exemption from California Workers' Compensation Insurance requirements. The form is designated as Attachment 7 and is used in conjunction with a Request for Proposal (RFP) process. The document requires the applicant to certify under penalty of perjury that they do not employ any persons in a manner that would subject them to California's Workers' Compensation Laws. The form includes fields for the RFP number, applicant's printed name, date, and signature.

The form establishes an ongoing compliance obligation, requiring applicants to notify the Department of Rehabilitation within ninety (90) days of any changes in their business operations that would result in becoming subject to California Workers' Compensation Laws. This attestation serves as a certification mechanism to document the exempt status of sole proprietors and individual contractors participating in state and local contract opportunities.

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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 .