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WORKERS' COMPENSATION DECLARATION <br />I Sergio Hernandez, Executive Vice President, hereby affirm under penalty of <br />(Name/Title) <br />perjury, the following declaration: <br />I certify on behalf of ThirdWave Corporation that during the term of my <br />(Consultant/Company Name) <br />contract for IT Assessment and Strategic RoadmaR services with the City of Santa Ana, <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 those provisions and provide proof of workers' compensation coverage. <br />DATE: 23 December 2014 <br />By: _6 <br />Name: Sergio Hernandez <br />Tittle: Executive Vice President <br />Telephone: 310.914 0186 <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 />