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FROM <br /> <br />PHONE NO. <br /> <br />Mar. 13 2003 06:27PM P1 <br /> <br />WORIcl~.!~' COMPENSATION DECLARATION <br /> <br />I hereby alTwm under penalty of perjury, the following declaration: <br /> <br /> I certify that during the term of my contract with the <br /> , City of Santa Ann, I will not employ any person in any <br />manner so as to become subject to the workers' compensation laws of California, and <br />agree that if I should become subject to the workers' compensation provisions of Section <br />3700 of the Labor Code, I shall forthwith comply with those provisions. <br /> <br />By: <br /> <br />Name: <br /> <br />Title: <br /> <br />Telephone: <br /> <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWI~3L, AND SHALL SUB. CT AN EM]PLOYI~R TO CRIMINAL PENALTIES <br />A2~D CIVIL FINI~ 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 TltE LABOR CODE, INTERF~T, AND ATTORNEY'S I~I~S. <br /> <br /> <br />