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Every employer, c <br />following ways: <br />(a) <br />By <br />aut <br />(b) <br />By <br />set <br />em <br />of <br />Ina <br />CHECK ONE <br />EXI41BIT "C' <br />COMPENSATION INSURANCE CERTIFICATION <br />the State, shall secure the payment of compensation in one <br />insured against liability to pay compensation by one or more in. <br />I to write compensation insurance in this State. <br />ng from the Director of Industrial Relations, a certificate of <br />e, either as an individual employer, or as one employer In <br />s, which may be given upon furnishing proof satisfactory to ti <br />-ial Relations of ability to self -insure and to pay any compor <br />me due to his or her employees. <br />X I am aware of he provisions of Section 3700 of the Labor Code which ret <br />employer to be insure against liability for Workers' Compensation or to undertake se <br />in accordance with th provisions of that Code, and I will comply with such provh <br />commencing the=par ormance of -the work work and activities required or permitted <br />Agreement. (Labor Codo §1861). <br />11110. FT�j{V44 <br />-- _-- workers' coi <br />I become an <br />-City with it <br />insurance. <br />representations made <br />PARKHOUSB TIRE <br />F <br />rming the work and activities required or pc <br />r person in any manner such that I become <br />tia. However, at any time, if I employ any pc <br />insation laws of California, immediately I sh <br />self -Insure, or a certification of workers' <br />jury under the laws of the state of California that the <br />certificate are true and correct. <br />INC. <br />9 <br />Inc. Agn:ement PY25.009$.docx-ms <br />Date: <br />of the <br />to <br />of <br />that <br />every <br />before <br />:r this <br />antler <br />to the <br />ih that <br />and <br />