Laserfiche WebLink
WORKERS' COMPENSATION DECLARATION <br /> I Linda O'Hanlon, President hereby affirm under penalty of <br /> (Name/Title) <br /> perjury, the following declaration: <br /> I certify on behalf of Straightline Communications that during the <br /> term of my contract with the Santa Ana Library, City of Santa Ana, I will <br /> (Organization Name) <br /> not employ any person in any manner so as to become subject to the <br /> workers' compensation laws of California and agree that if I should <br /> become subject to the workers' compensation provisions of Section <br /> 3700 of the Labor Code, I shall forthwith comply with those provisions. <br /> DATE: June 7, 2024 <br /> By: <br /> Name: Linda O'Hanlon <br /> Title: President <br /> Telephone: 818-386-1916 <br /> WARNING: FAILURE TO SECURE WORKERS' COMPENSATION <br /> COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO <br /> CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED <br /> THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF <br /> COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF <br /> THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br /> Risk MxnaanattDivis[on <br /> 3r� REVIEWED&APPROVED BY: <br /> I' 111f o A Aaty€ <br /> immix <br /> Risk Management Specialist <br />