Independent Contractor Statement Form for Cleaner and Cleaner Services LLC
I am an independent contractor with no employes, no casual laborers, and sub-contractors performing work for CLEANER AND CLEANER SERVICES LLC.
I am not the employee of CLEANER AND CLEANER SERVICES LLC, for workers compensation purposes, and therefore, I am no entitled to workers compensation benefits under their policy coverage. I waive any and all rights to file any claims against said employer in the event an accident should occur while, I am performing work on their premises.