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WORKERS' COMPENSATION DECLARATION <br />I Therese Robertson hereby affirm underpenally ofperjury, the <br />(Na=Title) <br />following declaration; <br />I certifyon bdhalfof 'Theresa Robertson that during.the term of my <br />contract for Recreation Classes "urbmDance" services with the City of Santa Ana, l.will <br />not employ anyperson in any manner ncr so as to :became subject to the workers' <br />compensation laws ofCaliforttiA, and agree that if Ishauld become subjeeitto Che <br />workers' eompensetionprovisions of Section 3700 of The Labor Cone, I shell fWthwit-it <br />comply with those provisions and provide pnoafof warkers'zoompensation coverage. <br />DATE:& jh-i? <br />BA <br />Title: RA <br />Telephone; W <br />-WARNING: FAILURETOSECUREWGRKERS"OGMIPENSATIONCO'VLRAGEIS <br />UN A�NDSHALL SUBJECTANEM�PLOYER'TOCRBM--4ALPFNALTMS <br />AND CIVII, FINES UP TO ONE HUNDRED THOUSAN!DDOLLARS(,$1,0,0,000). IN <br />ADDITION TO THE COST OF'COMPTINSATICK, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. <br />