Laserfiche WebLink
WORKERS' COMPENSATION DECLARATION <br />I Bruce T. Sherman / Owner hereby affirm under penalty of perjury, the <br />(Nama/Title) <br />Following declaration: <br />I certify on behalf of A PLUS Promotions that during the term of my <br />(Consulwt/Company Name) <br />contract for 04/20/19 — SaturdM services with the City of Santa Ana, I will not employ <br />any person in any manner so as to become subject to the workers' compensation laws of <br />California, and agree that if I should become subject to the workers' compensation <br />provisions of Section 3700 of the Labor Code, I shall forthwith comply with those <br />provisions and provide proof of workers' compensation coverage. <br />DATE: 03/26/19 By: 4 <br />Name: Bruce T. Sherman <br />Title: Owner <br />Telephone: 310-532-6223 Office / 310-686-2379 Cell <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 />