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WQRKE,R$' COMPENSATION DECLARATION <br />I Joshua Filler hereby affirm under penalty of perjury, the <br />(Natno/ritle) <br />following declaration <br />I certify on behalf of Filler Security Strategies, Inc. that during the term of my <br />(Consult uUCompany Name) <br />contract for homeland security consufiing 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 I 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: April 9, 2019 <br />By: <br />Joshua Filler <br />_._._. <br />eiplx9y stgonl i�y.loslrve finne <br />Joshua Filler..,.,,, ,,xo;;,, <br />Name: o.m: 261110.04 w,a:sa,sz.n.uo <br />Title: President <br />Telephone: (202) 279-1095 <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 ($100,000). IN <br />ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'$ FEES. <br />;W6� Ald-F�l <br />