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i <br />following dec <br />I certi <br />contract for <br />not employ ar <br />compensation <br />workers' corn <br />comply with t <br />DATE: Jan <br />WARNMG: F, <br />UNLAWFUL, e <br />AND CIVIL Fll <br />ADDITION TO <br />IN SECTION 3'. <br />hereby affirm under penalty of perjury, the <br />of Goldstone K-9, LLC <br />that during the term of my <br />— � ,r _ (ConsullanVCmm�snv N;,m., <br />services with the City of Santa Ana, I will <br />in any manner so as to become subject to the workers' <br />and agree that if I should become subject to the <br />Provisions of Section 3700 of the Labor Code, I shall forthwith <br />ions and provide proof of workers' compensation coverage. <br />2019 <br />By: Lance Bauer <br />Name: <br />Title: Owner <br />Telephone: 909-520-5050 <br />E TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />P TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />�-OST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />VED & APPROVED <br />NI,V,MjHVILM Doti ISION <br />812019 <br />M. LAMBERT <br />