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N.2018.058 <br />WORKERS' COMPENSATION DECLARATION <br />I Sandra Gee hereby affirm under penalty of perjury, the <br />(K.rrwe) <br />folLwipg declaration : <br />Icertify on behalf of_Full Spectrum Educational Services _that during the term <br />of my <br />(Coissvltan7CcmpenyNatne) <br />contract for,. Train services with the City of Santa Ana, Iwill 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: 03-01-2018 <br />By. <br />Name: <br />Sandee Gee <br />Title <br />Owner <br />Telephone: _949-496-6244 <br />WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS <br />UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRMNAL PENALTIES <br />AND CNII. FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN <br />ADDITION TO TEE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR <br />IN SECTION 3706 OF TEE LABOR CODE, INTEREST, AND ATTORNEY' S FEES. <br />PS\ J rd5 <br />