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INVESTIGATIONS <br />& CONSULTING, LLC <br />WORKERS' COMPENSATION DECLARATION <br />P.O. Box 29798 <br />Anaheim Hills, CA 92809-9798 <br />w ,msinvestigi6ons.eom <br />(714)779-2300 <br />I, Steve Rodig, Partner, hereby affirm under penalty of perjury, the following declaration: <br />I certify on behalf of RCS Investigations and Consulting, a California Limited Liability <br />Company Partnership [E1N 20-5065414] that during the term of my contract for <br />investigative services with the City of Santa Ana, I will not employ any person in any <br />manner so as to become subject to the workers' compensation laws of California, and agree <br />that if I should become subject to the workers' compensation provisions of Section 3700 <br />of the Labor Code, I shall forthwitheomply with those provisions and provide proof of <br />workers' compensation coverage. <br />Steve Rodig <br />RCS Investigations and Consulting, LLC <br />Partner/Owner <br />714-779-2300 <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'S FEES. <br />PJAMenarnenu) elan <br />i eC� RE\neneo&pAPPRovmar: <br />IW lL:r FAA1�liA*C M V(��AneRl <br />Risk ManagementMayst <br />