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WORICERS'QQMLENS&�FJQN DECLARAILON <br />I Donna Desmond, President hereby affirin undcr penalty of perjury, the <br />(Narie/Title) <br />fol I owing declaration: <br />I certify on behalf of Donna Desmond Associates —that during the ten -n of my <br />(Consultant/Company Name) <br />contractfior Goodwill Loss Appraisal serviceswith the City of Santa Ana, I will <br />not employ any person in any manner so as to become siibject to the workers' <br />compensation laws of California, and agree that if I sho-uld 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 />1230/2015 <br />DATE. / CONT AC #: A-201 4/679 andA-2015-159 <br />Nalne: Donna Desmond <br />Title: President <br />Teleplhone: , (310)475-111,4 <br />WARNING" FAILURE TO SECURE WONIERS' COMPENSATION COVERAGE IS <br />'UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO (.-MIMINAL PENALTIES <br />AND CIVIL FINES UPTO ONE HUNDRED THOUSkND DOLLARS (S 100,000). M <br />ADMION TO THE COST F COMPENSATION, DAMAGESAS PROVIDED FOR <br />IN SECTION 3706 OF THE, LIWOR CODE, INTERI,ST, AND ATTORNEYS FEES. <br />REVIEVVE) BY' , EUNICE B'ERELAA (P(r",V501F,w �) <br />