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WORKERS' COMPENSATION DECLARATION <br />I -Sandy Asch, Principal- hereby affirm under penalty of perjury, the <br />(Name/Title) <br />following declaration <br />I certify on behalf of _Alliance for Organizational Excellence LLC- that during <br />(Organization Name) <br />the term of my contract 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 <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 wi ' <br />DATE: ~~ ' b Z~Q <br />~o~' <br />A5 Z~ <br />,~,'fl <br />~'Q~`~ ~' S.~pP~ o Bey <br />~~SP ~ G~~y <br />Pss~~~ar <br />By: Alliance for Organizational Excellence LLC._ <br />Name: -Sandy Asch <br />Title: Principal <br />Telephone: (858) 482-7742 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRINIlNAL PENALTIES AND <br />CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION <br />TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 <br />OF THE LABOR CODE, INTEREST, AND ATTORNEY' S FEES. <br />