Laserfiche WebLink
Auto Liability (Non -Use Agreement) <br />Date 5 / (� / ZA <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />Re: Auto Insurance Requirement <br />Dear City of Santa Ana Risk Management Division: <br />SWtMhas intent to enter into an agreement with the City of Santa <br />Ana. Throughout the course of this agreement CAe, dv.� attests to the following: <br />1. V,,) (ny�/ will not use/drive anyvehicle during the course <br />and scope of the service 3 provided in the agreement contract <br />2. Sv\j j fA CAVV will not use any owned/rented/leased vehicles <br />during thecourse aM scope of the services provided in the agreement/contract. <br />3. �j ft\�WAJ_q consultants/independent contractors/employees <br />utilize their personal vehi es/noncompany owned, borrowed, or rented/leased <br />vehicles for transportation to and from work and if applicable carry their own <br />automobile insurance. "� imp <br />By signing below, I, eplSytt�1G'C..��� "'attest that I possess the legal authority <br />to enter into an agreement with the City of Santa Ana as well as the legal authority <br />to attest to the statements above. If at any time it is found that <br />is not adhering to any/ail statements in this document and has not provided the <br />minimum Auto liability insurance coverage of $1 million per occurrence, the contract <br />will be considered null and void andthe company will be held fully liable for any and all <br />damages. <br />Signature: k <br />Name: <br />Job Title: C r^�� <br />Company Name: li _ <br />Contact Phone: C " fV\ S(-�1 J� <br />Email Address: ­ U 1-C && ` `�j./1 <br />,,,g. KIdrM�nm,�,IpR ,y <br />'� REVIEWED6 APPROV®BY: `S <br />gy�Aza ;n <br />1ll�+. <br />Risk Mznagement Spedalisl <br />