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I Lance <br />(N <br />er; <br />following dech <br />rati( <br />I certi <br />on I <br />contract for K <br />9 1 <br />not employ any <br />per$ <br />compensation laws <br />4 <br />workers' comp <br />nsat <br />comply with those <br />p <br />DATE: Janu <br />ry <br />WARNING: Fl <br />UNLAWFUL, E <br />AND CIVIL Fir <br />ADDITION TO <br />IN SECTION 3, <br />auer hereby affirm under penalty of perjury, the <br />of Goldstone K-9, LLC <br />that during the term of my <br />services with the City of Santa Ana, I will <br />i in any manner so as to become subject to the workers' <br />California, and agree that if I should become subject to the <br />n provisions of Section 3700 of the Labor Code, I shall forthwith <br />visions and provide proof of workers' compensation coverage. <br />3, 2019 <br />By. Lance Bauer <br />Name: < �� <br />Title: Owner <br />Telephone: 909-520-5050 <br />E TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES <br />P TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />;OST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />✓ED & APPROVED <br />149nr<agem Ni DwisiON <br />312019 <br />M. LAMBERT <br />