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I ,Deborah F. McIntosh _ hereby affirm under penalty of perjury, the <br />(NMWTOC) <br />following declaration <br />I certify on behalf of History Through the Eyes of Women_ that during the term <br />of my <br />"WIN"Mmopony NORM) <br />contract for —41h of July Entertainment _ services with the City of Santa Ana, I will not <br />employ any person in any manner so as to become subject to the workers' compensation <br />laws of California, and agree that if I should become subject to the workers' <br />compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply <br />with those provisions and provide proof of workers' compensation coverage. <br />DATE: ea & yyg <br />Name: Deborah F. McIntosh l /f ,-_ %qc� 1' <br />Title: _Pre sidcaToundcr ,7 %' 44 ,a" <br />Telephone: (661) 803-2240 fo40/-&-3 ' 2 Z ¢O <br />WARNING: FAILURE. TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO THE COST OF COMPEENSATION, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, <br />6a0& <br />1 eo <br />S\\4\�a-G�iPd��r <br />RGSP <br />P <br />