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WORKERS' COMPENSATION DEC.1-ARATION <br />1, Rodolfo Cazales dba Foyama Karate -Do, hereby affirm under penalty of <br />perjury, the following declaration : <br />I certify on behalf of —Toyama Karate -Do_ that during the term of my <br />(Consultant/Company Name) <br />contract for Karate Classes services with the City of Santa Ana, I will not employ any <br />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 />FAMNIMM, <br />a <br />By: <br />/0101, <br />UM= <br />