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N-2018A 24 <br />I _Deborah F, McIntosh _ hereby af0rna under penalty of perjuy, the <br />tNMIw Fats} <br />following declaration <br />I certify cart behalf of )History Through the Eyes of Women_ that during the tent <br />of any <br />(V:W184apnU�t'utn(gny N'+rncp <br />contract for _4P Of July Entertainment _ sen-ices wAith the City of Santa Ana, I will not <br />employ any person in any manner so as to bccome subject to the workers` compensation <br />laws orcat I rorma. and agree that irI should become subject to the Workers' <br />compensation provisions of Section 37DO of the Labor Code, I shalt forthwith comply <br />with those provisions and provide proof of work -cm' compensation coverage. <br />BATE: ,lam' el/ <br />8va? " <br />Name: —Deborah F. McIntosh <br />"Bike; �1�raAaitlarrattl�ouna?t~r - G,��,�1�'��'.�u�2'�C� <br />"Telephone: (1) 803-224(t Ca 6- <br />WARNING: F+ IT-IURf TO SECIIIRG k&'ORKE.RS° CO PFNiSATION Ct VF} ,R.At;r IS <br />UNLAWFUL, AND SHALL 5UBJI-CI' AN EIMPLOYER TO CRIMINAL PEN'ALTIrs <br />AND CIVIL HNES Urro ONE 14UNDRED THOUSAND DOLLARS tSI O0,Lt00). IN <br />,ADDITION TO THE COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATFORN13Y' 4 I I GS,. <br />