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WORKERS'C ..O.MPENSATION DEC[AgM <br />voly lb LOW 1XIVby drirnl undcr pesully of verjo ry, 111c <br />following dec laradoll <br />colbi Cy on; bulial f of thal duHng flic term of my <br />contfut for Recro.abkon Classes rvices: with the City of Santa Ana, I will <br />"ot C111p;JOY any persom ii'l ally manner So as to Nxofu Subjec-1 11) Ole workers' <br />ctwo-usatioll taw l or Cal lJorn la, md are that if � sl mi come subject.to aw <br />wPvkcr5' o;F&ctlon 37worthe LabuCgdc, I $hall forlh%dth <br />comply withthose provisions udr,provklv, pruofof workefs' compusadon coverap, <br />D.&TE: 5.1-m <br />M <br />....... . . . . . . . . . . . . . . <br />N DWO(8 LAW <br />11'(tcl <br />Tcicphow: 1114),Xg- *44 010" <br />WARNING, FAIL U RE TO: SECURE WORKE RYCOM.FENS AT [ON COVERKE, [8 <br />UNLAWFUL, AND SMALL SUBJECTAN ENTFLOYER TO CRIMINAL PENALTIES <br />AND CIVIL FINES UP TX) ONE HINDREDTHOWSAND DOLLARS IN <br />ADMION TOTHE COSTOF COMPENSATION, DANIAGES ALS PROVIDED FOR <br />IN SI-XV04N 3706 0 VIIIE LA 13011 CO ME, INTE R E ST, AND ATT EY"S FEES. <br />