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WORKERS' COMPENSATION DECLARATION <br />I Trevor -Yates; hereby affirm under penalty of perjury, the <br />a:m--rule) <br />follouing declaration: <br />I certify on behalf of _ Ventura Business Systems that during the term <br />of my (c01M1, VC0MPM • N=e) <br />contract for 5 vears 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: 118.2019 <br />By <br />Name: Trevor Yates <br />Title: President <br />Telephone: 305-533-3299 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNL4INFUL ,AND SHALL SUBJECT AN EMPLOYER TO CREvE tAL PENALTIES <br />AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO THE COST OF COMPENSATION, DAMNGES AS PROVIDED FOR <br />IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. <br />