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CITY OF SANTA ANA <br />RISK MANAGEMENT di vwa 4HUMAN RESOURCES <br />Managing Risk ommigh Posltive Change <br />WORKERS' COMPENSATION DECLARATION <br />Linda O'Hanlon/President <br />(Name/Title) <br />following declaration: <br />0 <br />hereby affirm under penalty of perjury, the <br />I certify on behalf of Straightline Communications <br />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: March 10, 2021 <br />Print Name: Linda O'Hanlon <br />Print Title: President <br />Signature: f Date:2021.03.10 <br />18:19:20-08'00' <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 />I: Risk Mgmtllnsurance Requirements �WC Declaration 08152019 <br />h <br />Rtek MankgemmL Diwelan <br />REVIEWEDS APPROVEDBY: <br />F",� R. vjz,� <br />Risk Management Anatyst <br />