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WORKERS' COMPENSATION DECLARATION <br />I Claudia Lipp, President hereby affirm under penalty of perjury, the <br />(Name/Title) <br />following declaration <br />I certify on behalf of _Readwrite Educational Solutions Inc._ that during the term of my <br />(Consultant/Company Name) <br />contract for _contract_ services with the City of Santa Ana, I will not employ any person in <br />any manner so as to become subject to the workers' compensation laws of California, and agree <br />that if I should become subject to the workers' compensation provisions of Section 3700 of the <br />Labor Code, I shall forthwith comply with those provisions and provide proof of workers' <br />compensation coverage. <br />DATE: December 20, 2016 <br />By. — CXQ l CGI�cZ — <br />Name: _Claudia Lipp_ <br />Title: President <br />Telephone: _949-263-0633_ <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND <br />CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN <br />SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />