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WORKERS' COMPENSATION DECLARATION <br />1 Lance Bauer hereby affirm under penalty of perjury, the <br />(Name(ritle) <br />following declaration <br />I certify on behalf of Goldstone K-9, LLC that during the term of my <br />u°mnyName) <br />contract for K-9 Trainin /E iPmen <br />pa <br />services with the City of Santa Ana, I will <br />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 become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: January 23, 2019 <br />By: Lance Bauer <br />T <br />Name: <br />Title: Owner <br />Telephone: <br />909-520-5050 <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 />