Laserfiche WebLink
WORKERS' COMPENSATION DECLARATION <br />I Kevin Noonchester hereby affirm under penalty of perjury, the <br />(Nstne/Title) <br />following declaration: <br />I certify on behalf of Noteworthy Puppets Inc. that during the term of my <br />(Consultant/Company Name) <br />contract for Library Performer services with the City of Santa Ana, I will not employ <br />any person in any manner so as to become subject to the workers' compensation laws of <br />California, and agree that if I should become subject to the workers' compensation <br />provisions of Section 3700 of the Labor Code, i shall forthwith comply with those <br />provisions and provide proof of workers' compensation coverage. <br />DATE: April 19, 2016 <br />By: <br />Name: Kevin Noonchester <br />Title: Owner <br />Telephone: (323}524-7469 <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 />Mani ue t�osales <br />q <br />SAPL/Youth Services <br />