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N-2018-181 <br />�OI�iCERS' COMPENSATION IJECLARATIOIV <br />I Reyna Grande hereby aftina under penalty of perjury, the <br />(NamQ/Tide) <br />following declaration <br />I certify on behalf of Reyna Grande that diu ing the term of my <br />(CoavultairUCbmpauy Nuu�e) <br />contract for A ({hpr Event 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 laws of California, and agree that if should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: <: 09/ 14 / 201 B <br />Name: Reyna Grande <br />Title: Author <br />Telephone: 3233141330 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SEIALL 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 />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />