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REV: 02-11-25 LF <br />EXHIBIT “D” <br />Declaration <br />DECLARATION REGARDING WORKERS’ COMPENSATION INSURANCE AND <br />EMPLOYER’S LIABILITY INSURANCE <br />Subrecipient certifies that it has only one employee, that such employee is a director of <br />the firm and that such employee has elected not to be covered by workers’ compensation <br />insurance in accordance with an exception to the requirement of workers’ compensation <br />insurance coverage as provided for under Section 3351 (c) of the California Labor Code. <br />Subrecipient agrees to purchase workers’ compensation insurance if it retains any <br />additional employees during the term of this Agreement. Being that the Subrecipient does <br />not have any employees that are not owners of the firm, Subrecipient does not carry <br />Employer’s Liability Insurance. <br />Subrecipient: _________________________ <br />Printed Name: __________________ <br />Title: __________________________ <br />ATTY/AGR.2025.021/Step Into a Job! (Pandemic Readiness Healthcare Job Training) (Page 21 of 21) <br />6.F. - Page 36 of 36 <br />155