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12119/2 013 14:18 17604163320 AINI MAIL CENTER 46 PAGE 02/08 <br />WORKERS' COMPENSATION DLC�AR1•LTION <br />I, Qharlotte D. WhitW rL hereby affirm under penalty of petjury, the <br />(Namelride) <br />following declaration: <br />I certify on behalf of StrategioSolutlous that during the term of my <br />(Ofgoni>.atian Namo) <br />contract with the Facilities Fleet and Central Stores .Division, City of Santa Ana, I will <br />not employ any person in any manner so as to become suhiect 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. <br />DA'Z'E: Z-2 i %.�-3 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI)YIINAL PENALTIES <br />AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO T14E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />rN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S PEES. <br />