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<br />WORKERS' COMPENSATION DECLARATION <br /> <br />I Elson T omaz De Cantuaria hereby affirm under penalty of perjury, the <br />following declaration : <br /> <br />I certify on behalf of Match Point Tennis Academy LLC that during the term of <br /> <br />my contract with the Parks. Recreation & Community Services Agency. City of Santa <br /> <br />Ana, I will not employ any person in any manner so as to become subject to the workers' <br /> <br />compensation laws of California, and agree that if I should become subject to the <br /> <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith <br />o / <br /> <br />:::~i;;::77 z;z -7;/ccL <br /> <br />( / --' <br /> <br />By Elson Tomaz De Cantuaria <br /> <br />Name: Elson Tomaz De Cantuaria <br /> <br />Title: Manager/Owner <br /> <br />Telephone: (714) 724-9407 <br /> <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 ATIORNEY'S FEES. <br />