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ACADEMY OF INTERNATIONAL DANCE 10
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ACADEMY OF INTERNATIONAL DANCE 10
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Last modified
6/22/2020 12:39:25 PM
Creation date
9/26/2018 12:14:30 PM
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Contracts
Company Name
ACADEMY OF INTERNATIONAL DANCE
Contract #
N-2018-006-01
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
12/31/2018
Insurance Exp Date
12/31/2018
Destruction Year
2023
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N-2018-006-01 <br />WORKERS' COMPENSATION DECLARATION <br />I Sonia Miskulin, Director hereby affirm under penalty of perjury, the <br />(Name/Title) <br />following declaration <br />Academy of International Dance <br />I certify on behalf of that during the ten -n of my <br />Dance Instruction (ConsultatiHComrany Name) <br />contract for services with the City of Santa Ana, I will <br />not employ any person in any manner so as to become subject to the workers' <br />compensation taws of California, and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shalt forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: 01130/2018 <br />By — -- <br />Name: Sonia Miskulin <br />Title: Director <br />Telephone: (714) 550-9285 <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 COMPENSATION, DAMAGES AS PROVIDED FOR <br />1N SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />
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