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11iORKERS' COMPENSATION DECLARATION <br />I Trevor Yates President hereby affirm tinder peiniltv of perjiwy the <br />Nam mile) <br />following declaration <br />I certify on behalf of Ventura Business Systems. Inc that during the terns <br />Of my (cmm?"'ccogmyName) <br />contract for 5 tears services ttith the City of Santa Ana, I Hill not <br />employ any person in any manner so as to become subject to the workers' compensation <br />latvs of California, and agree that if I should become subject to the workers' <br />compensation provisions of Section 3700 of the Labor Code, I shall forthxvith comply <br />with those provisions and provide proof of workers' compensation coverage. <br />DATE: 7/10/2018 j <br />By <br />Narrwe: Trevor Yates <br />Title: President <br />Telephone: 805-583-3299 <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 />eday'. <br />Rev�e�,l� L��3 <br />P�GgR <br />