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REV: 04-13-26 MI <br />EXHIBIT C <br />WORKERS’ COMPENSATION REPRESENTATION <br />If VENDOR does not have any employees and does not wish to cover themselves <br />for workers’ compensation, the VENDOR shall sign the following statement, as well as <br />the Agreement itself, to effect a fully initiated Agreement: <br />I, as designated VENDOR, do not have, nor intend to have, for the full term of this <br />Agreement any employees as defined under applicable state law. Furthermore, I do not <br />wish to obtain or be covered under any workers’ compensation insurance coverage; <br />and, therefore, am signing this Representation certifying that VENDOR is exempt from <br />the requirement to maintain a workers’ compensation policy as defined under applicable <br />state law and is in compliance with the insurance requirements outlined in this <br />Agreement. <br />Signature: <br />Date: 4/2/26 <br />Business Name: Cross Connection Emergency Services, Inc. <br />ATTY/AGR.2026.102/Cross Connections Emergency Services Inc. (Portable Radios & Accessories Purchase) (Page 11 of 11)