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WORKERS' COMPENSATION DECLARATION <br />I Randy Sorley hereby affirm under penalty of perjury, the <br />(Nameffitle) <br />following declaration: <br />I certify on behalf of RCS investigations that during the term of my <br />Background (Con1.t/C.pany Nam.) <br />contract for _ 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, I shall forthwith <br />comply with those provisions and provide proof of workers' compensation coverage. <br />DATE: <br />10/06/2019 <br />By: Randy Sorley <br />Name: <br />Title: <br />Partner <br />Telephone: <br />714-779-2300 <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 />ng� <br />% 4 <br />Risk %teaganadD istan <br />RWex & ArrRov®ar. <br />P. VwAud <br />R¢k Management a,ayst <br />