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WD ERS' COMPENSATION DECLARAT ON <br />I, Alvin W, Tsang, hereby affirm under penalty of perjury, the <br />(.NameFritlo) <br />following declar tion : <br />I certify on behalf of _ Alvin W. Tsang _ that during the term of my <br />(Conottant/Company Name) <br />contract for Speaker/Author Presentation event _ 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 became subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith <br />comply with those provisions and provide proof of wormers" compensation coverage. <br />DATE: 2116117 <br />Name:..... Alvin W. Tsang <br />Title: Filmmaker <br />Telephone: 213.820.9608 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />AND CIVII. FINES UP TO ONE HUNDRED T14OUSAND 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 />