CERTIFICATE OF EXEMPTION FROM WORKER’S COMPENSATION LAWS
CERTIFICATE OF EXEMPTION FROM WORKER'S COMPENSATION LAWS
I am aware of the provisions of California Labor Code Section 3700, which requires every employer to be insured against liability for workers' compensation or to undertake selfinsurance in accordance with the provisions of that code. I affirm that at all times in performing the work for which this Certificate is provided I will not employ any person in any manner so that I become subject to the workers' compensation laws of California. I also understand that if while performing the work for which this Certificate is provided I employ someone so that I become subject to the workers' compensation laws of California, the claim of exemption executed under this form will no longer be valid. I affirm that if I become subject to the workers' compensation laws of California while performing the work for which this Certificate is provided I will obtain a Certificate of Workers' Compensation Insurance, submit that Certificate to Resources Legacy Fund immediately following its effective date, and continuously maintain the coverage provided by the Certificate in accordance with the law.
I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and accurate.
Signature: ________________________________ Date: ___________________
Name: __________________________________
Title: __________________________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- waiver and release of liability agreement
- department of labor and employment division of colorado
- workers compensation waiver form
- workers compensation and employers liability insurance policy
- declaration of independent contractor status form
- colorado department of labor and employment division of
- affidavit of exempt status under the workers compensation act
- workers compensation waiver iowa
- independent contractor waiver of workers compensation
- workers compensation claim form dwc 1 notice of
Related searches
- workers compensation laws by state
- workers compensation laws ny state
- workers compensation laws new york
- workers compensation certificate of insurance
- workers compensation laws state comparison
- certificate of attestation of exemption ny
- workers compensation certificate of exemption
- workers compensation laws in california
- certificate of attestation of exemption ce 200
- new workers compensation laws ca
- workers compensation laws in wisconsin
- workers compensation laws for employers