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I, <br />CITY OF SANTA ANA <br />RISK MANAGEMENTa &wacoa 4HUMAN RESOURCES <br />Managlnq Rtsk mrotvh Posture Change ` <br />WORKERS' COMPENSATION DECLARATION <br />hereby affirm under penalty of perjury, the <br />(Nome/Title) <br />following declaration: <br />Linda O'Hanlon <br />I certify on behalf of Straightline Communications that during the term <br />(Consultant/Company Name) <br />of my contract for marketing and communications services with the City of Santa Ana, <br />(Type of service provided) <br />I will 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, I shall forthwith <br />comply with the provisions and provide proof of workers' compensation coverage <br />immediately. <br />Date: February 14, 2020 z <br />Print Name: Linda O'Hanlon <br />Print Title: President <br />Signature: LindaO'Hanlon <br />wrmxio? is i i»-ss arar <br />Telephone: 818-386-1916 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND <br />SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED <br />THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS <br />PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />By VM REVIEWED &APPROVMEW SEEDD <br />MAW20 <br />ANOE AcEvEdO <br />1:lRisk Mgmtllnsuronce Requirements�WC Declaration 08152019 <br />