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WORKERS' COMPENSATION DECLARATION <br />I Trevor Yates President hereby affirm under penalty ofperjury, the <br />(N=erritle) <br />following declaration: <br />I certify on behalf of Ventura Business Systems Inc. that during the term <br />of my <br />(Consult anNCompany Name) <br />contract for 5 Years services with the City of Santa Ana, I will not <br />employ any person in any manner so as to become subject to the workers' compensation <br />laws of California, and agree that if I should become subject to the workers' <br />compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply <br />with those provisions and provide proof of workers' compensation coverage. <br />DATE: 5/30/2017 <br />By: ��.. <br />Name: Trevor Yates <br />Title: President <br />Telephone: (805) 583-3299 ext 101 <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 FEES. <br />ea <br />5��\GSPP <br />