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<br /> LI4LNSEDCONTRACTORS DECLARATION
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<br /> L`II Paye C'aatrnlor
<br /> EErI{1{ OWNP.WRUILOER OECLARATION
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<br /> tamplrlmn,the aatn[rbecldv will h+.e dk hurrfen afpmv ng lNiht dA uor Ppultlm nsrJebvt fW she w@ou o[m/r.)
<br /> }YIYY/III I.x owner of 11W propmy,om r los ly eunbat irtg w.Ih Hamad eawactoa.to e:ttauYU the Pwpccr(Socom 700 Pta K
<br /> rnr3 RWfessiM3 fads lR&PCI Thr Coo,"w,i Li&..Law dbes>ux ypply m is otwxf of'"ny who WIMP or mVmla
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<br /> WO1 RW C0V4PT2+5ATION DECLARATI IN
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<br /> 4 O CenifWd'e"n fiat with Oe Eaviemn mj Nrahh Dry eremrnL
<br /> CERTIFICATE OF KXEIILPTION pROM WORKERS`COMPENSATION INSLiRANCE
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<br /> !cerrlfy thu�n du prvfen .aflhe wart fm whkh dais Prrour u iw.,L 1,1011 n,A emplo nay person m any manner sa u to
<br /> r batotrc srbjaT W the U'arlen:'C.mlgp xklm Laws efC331fomu
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<br /> Y'OTN`E TO APPLICANT. If, A. m4iej This CpUfkw of Eurp., YW fMeld Maanq Wddiet IV the YFmked
<br /> Compo t,.prwisiom of flee Lobar to -.You-Mi fodNwith omryly welh rxh rt 'giww M Ihis peen "-M be dcenied ravatbl
<br /> Con,IRT�CTIOM LENDIN12 AGENCY
<br /> i hemby.ffi.tient W=,t SMSWbstari lending WQ&P fbrdli M"UrRIWeOa et*s Writ far whech rhes P-Q*Qr iraW ISetltaW
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<br /> Vi 1tadtr-s Natio.
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<br /> DIVISION OF 114DUSTRPAL SAFETY PER.NIT WMCAT1ON
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<br /> j ...Q with.wh eoMwlrwt byd:Q Panna and Nie no builds". Wve.matTMdiay.rjl Mmk.x dk lmow w deo Qodiag
<br /> fl tkereef.will ba twre than fhinysi,1367 fen high[Chttner 1:,('Op 2.AM'ie)-2.sarlion 331,TM.Y.Ca1'roM4 Adminiwaina
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<br /> _ I D As mwtwr-Swiresr,I will not emplaY a Yana w do work which wouA MW"a Parma from Loc Division of toAutriet Satay.m
<br /> riofeJ abusa-4Vm..uch per rvhm a PeoM W dosuch wok from Ute divuien.
<br /> I cttt.f,till I Fire rrad Ihta apojNa and IAW dat the above tn(WMk,M if MrrecL I bjrae b WI*Y wOA MI WY and COUWY
<br /> � 6hiihk6tei LtdiLYe lawn rCliAnY:bveltanlfismgW and Or'%wnYe aYFiHe Canama[llan,led hettbY aultwhrt rtpYeleMMilY3af dl6a
<br /> cewNy McMu upon ttu ibVva.reWntioned property for W.Portion 0,.Va .
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<br /> 11/10/2011
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