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WORKERS' COMPENSATION DECLARATION <br />Sergio Hernandez, ExecutiveV.P. <br />I hereby affirm under penalty of perjury, the <br />(Name/Title) <br />following declaration <br />I certify on behalf of ThlydWave Corporation that during the term of my <br />(Organisation Name) <br />contract for 01411e1RemM. Ne�A..u.111od mplemenmaonPh. services With the City of Santa Ana, I <br />will not employ any person in any manner so as to become subject to the workers' <br />compensation laws of California, and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith <br />comply with those provisions, <br />DATE: 04/07/2016 <br />By: cuc <br />Name: Sergio a nan`dez <br />Title: <br />Executive Vice President <br />Telephone: <br />310.914.0186 <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 TIIE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />icy <br />