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WORKERS' COMPENSATION DECLARATION <br />I Linda O' H a n I O n hereby affirm under penalty of perjury, the <br />(Name/Title) <br />following declaration: <br />I certify on behalf of Straightline Communications that during the term of my <br />(Organization Name) <br />contract with the Water Resources Division , City of Santa Ana, I will not <br />employ any person in any manner so as to become subject to the workers' compensation <br />laws 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 forthwith comply <br />with those provisions. <br />DATE: June 8, 2018 <br />Lo <br />Digitally UgneJ by UnG DHanbn <br />Linda O'Hanlon <br />small=°ha.....tlinxomm.[am,[=U5 <br />Dale E01006.1E 1.:..1&19A)'O]' <br />Name: Linda O'Hanlon <br />Title: President <br />Telephone: 818-386-1916 <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 ($100,000). IN <br />ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />J <br />A- Zci$ o8(,. <br />60jop, Brfz- a te- f <br />